Individual
CHARLES C. CLAUSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
13055 W MCDOWELL RD, SUITE G103, AVONDALE, AZ 85323-6449
(623) 848-0100
(623) 848-3516
Mailing address
13055 W MCDOWELL RD, SUITE G103, AVONDALE, AZ 85323-6449
(623) 848-0100
(623) 848-3516
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3245
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3245
STATE LICENSE
AZ
01
—
609902
UNITED CONCORDIA PROVIDER
—
Enumeration date
11/20/2006
Last updated
07/08/2007
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