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Individual

CHARLES E EARNHARDT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
949 N 14TH ST, LEESBURG, FL 34748-3838
(352) 460-0164
(352) 460-0164
Mailing address
926 GREAT POND DR STE 2003, ALTAMONTE SPRINGS, FL 32714-7244
(407) 772-5124
(407) 788-3572

Taxonomy

Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
DN18116
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
107915500
FL
Enumeration date
08/31/2007
Last updated
01/26/2021
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