Provider Demographics
NPI:1912523234
Name:SANNA CHARLIE DDS PC
Entity Type:Organization
Organization Name:SANNA CHARLIE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-895-5268
Mailing Address - Street 1:PO BOX 2812
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-0812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 FENTON ST STE 10
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4148
Practice Address - Country:US
Practice Address - Phone:925-447-8635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty