Organization
BRIAN W CHARLES DMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN W CHARLES DMD (OWNER)
(208) 634-7653
Entity
Organization
Contact information
Practice address
509 PINE ST, MCCALL, ID 83638-5017
(208) 634-7653
(208) 634-4568
Mailing address
509 PINE ST, MCCALL, ID 83638-5017
(208) 634-7653
(208) 634-4568
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
N-08582
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002547300
—
ID
Enumeration date
08/20/2010
Last updated
08/20/2010
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