| Brian W Charles Dmd | |
|
509 Pine St Mccall ID 83638-5017 | |
| (208) 634-7653 | |
| (208) 634-4568 |
| Full Name | Brian W Charles Dmd |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 509 Pine St, Mccall, Idaho |
| Authorized Official Name and Position | Brian W Charles (OWNER) |
| Authorized Official Contact | 2086347653 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brian W Charles Dmd 509 Pine St Mccall ID 83638-5017 Ph: (208) 634-7653 | Brian W Charles Dmd 509 Pine St Mccall ID 83638-5017 Ph: (208) 634-7653 |
| NPI Number | 1023324621 |
|---|---|
| Provider Enumeration Date | 08/20/2010 |
| Last Update Date | 08/20/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023324621 | NPI | - | NPPES |
| 002547300 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | N-08582 (Idaho) | Primary |
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