Provider Demographics
NPI:1740701168
Name:CHARLES, JAYTRON ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:JAYTRON
Middle Name:ROBERT
Last Name:CHARLES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 E 132ND ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-4587
Mailing Address - Country:US
Mailing Address - Phone:818-564-5098
Mailing Address - Fax:
Practice Address - Street 1:5318 ALLENTOWN PIKE
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:PA
Practice Address - Zip Code:19560-1249
Practice Address - Country:US
Practice Address - Phone:610-502-4553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001818122300000X
PADS0435341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No122300000XDental ProvidersDentist