Provider Demographics
NPI:1154900371
Name:JEAN-CHARLES, CHARLINE (RDH)
Entity type:Individual
Prefix:MS
First Name:CHARLINE
Middle Name:
Last Name:JEAN-CHARLES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3412
Mailing Address - Country:US
Mailing Address - Phone:786-797-8134
Mailing Address - Fax:
Practice Address - Street 1:6432 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6820
Practice Address - Country:US
Practice Address - Phone:407-293-9573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH23856124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist