# CHARLES R DISDIER DDS PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Immediate Dental Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962544197
- **Authorized official:** DR. CHARLES R DISDIER DDS (DENTIST)
- **Authorized official phone:** (252) 243-8448

## Contact information

- **Practice address:** 1468 TARBORO ST W, SUITE F, WILSON, NC 27893-1509
- **Practice address phone:** (252) 243-8448
- **Practice address fax:** (252) 243-9503
- **Mailing address:** 1468 TARBORO ST W, SUITE F, WILSON, NC 27893-1509
- **Mailing address phone:** (252) 243-8448
- **Mailing address fax:** (252) 243-9503

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6975 | NC | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 06/18/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5901593 | — | NC |