Provider Demographics
NPI:1801389184
Name:CHARLES-MARCEL, ADRIEN LANCELOT (DDS, MD)
Entity type:Individual
Prefix:
First Name:ADRIEN
Middle Name:LANCELOT
Last Name:CHARLES-MARCEL
Suffix:
Gender:
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LLUSD DEPT. OF ORAL & MAXILLOFACIAL SURGERY ROOM 3306
Mailing Address - Street 2:11092 ANDERSON STREET
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-0001
Mailing Address - Country:US
Mailing Address - Phone:909-558-4671
Mailing Address - Fax:
Practice Address - Street 1:11092 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-3177
Practice Address - Country:US
Practice Address - Phone:909-558-4423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX412721223S0112X
390200000X
CA103637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist