Provider Demographics
NPI:1780894170
Name:PAYERLE, CHARLES RICHARD JR (DDS MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:PAYERLE
Suffix:JR
Gender:M
Credentials:DDS MD
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Mailing Address - Street 1:12001 S FREEWAY
Mailing Address - Street 2:#207
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028
Mailing Address - Country:US
Mailing Address - Phone:817-568-6811
Mailing Address - Fax:
Practice Address - Street 1:12001 SOUTH FWY STE 207
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7214
Practice Address - Country:US
Practice Address - Phone:817-568-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAS-355204E00000X
TX00237351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery