Provider Demographics
NPI:1194163618
Name:CHARLES, ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:CHARLES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 OAK LAWN AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4788
Mailing Address - Country:US
Mailing Address - Phone:214-699-4976
Mailing Address - Fax:
Practice Address - Street 1:3607 OAK LAWN AVE STE 250
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4788
Practice Address - Country:US
Practice Address - Phone:214-699-4976
Practice Address - Fax:214-712-4940
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX306811223G0001X, 1223S0112X, 122300000X
DCDEN1001373122300000X
MD15418122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist