Individual
CHARLES WILLIAM MATTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4800 LAKEWOOD RANCH BLVD, BRADENTON, FL 34211-4953
(941) 405-1603
Mailing address
1820 NE JENSEN BEACH BLVD, JENSEN BEACH, FL 34957-7212
(325) 829-4069
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14784
TX
122300000X
Dentist
685
FL
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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