Individual
DR. CHARLES JOSEPH MUSTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
920 WYOMING AVE, STE 104, FORTY FORT, PA 18704-3970
(570) 283-3611
(570) 283-3396
Mailing address
920 WYOMING AVE STE 203, FORTY FORT, PA 18704-3999
(570) 283-3611
(570) 283-3396
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DS027522L
PA
207L00000X
Anesthesiology Physician
DP027522A
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
727338
PA BLUE SHIELD
PA
01
—
808758
FIRST PRIORITY HEALTH BC
PA
Enumeration date
09/02/2006
Last updated
05/30/2023
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