Provider Demographics
NPI:1780784157
Name:SACKS, CHARLES H (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:SACKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:921 N BETHLEHEM PIKE
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477
Mailing Address - Country:US
Mailing Address - Phone:215-646-4767
Mailing Address - Fax:215-646-5140
Practice Address - Street 1:921 N BETHLEHEM PK
Practice Address - Street 2:
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477
Practice Address - Country:US
Practice Address - Phone:215-646-4767
Practice Address - Fax:215-646-5140
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024384L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice