Individual
CHARLES VERNON ENWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3099 E WASHINGTON AVE, MADISON, WI 53704-4338
(608) 240-5120
Mailing address
3099 E WASHINGTON AVE, MADISON, WI 53704-4338
(608) 240-5120
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001839
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33352800
—
WI
Enumeration date
08/13/2006
Last updated
08/14/2012
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