Provider Demographics
NPI:1952515637
Name:ANDERSON, CHARLES MIDDLETON (DMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MIDDLETON
Last Name:ANDERSON
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 1:317 WINGO WAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-1803
Mailing Address - Country:US
Mailing Address - Phone:843-884-2021
Mailing Address - Fax:843-884-6910
Practice Address - Street 1:317 WINGO WAY
Practice Address - Street 2:SUITE 301
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1803
Practice Address - Country:US
Practice Address - Phone:843-884-2021
Practice Address - Fax:843-884-6910
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2694122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice