Provider Demographics
NPI:1811960677
Name:DENNIS, CHARLES W (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:DENNIS
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 1:116 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1056
Mailing Address - Country:US
Mailing Address - Phone:570-587-4031
Mailing Address - Fax:570-587-8823
Practice Address - Street 1:116 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1056
Practice Address - Country:US
Practice Address - Phone:570-587-4031
Practice Address - Fax:570-587-8823
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031500L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice