Provider Demographics
NPI:1215958343
Name:SANNAR, CHARLES NED (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:NED
Last Name:SANNAR
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 1:287 OBRIEN AVE
Mailing Address - Street 2:
Mailing Address - City:GRIDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95948-9603
Mailing Address - Country:US
Mailing Address - Phone:530-846-0243
Mailing Address - Fax:
Practice Address - Street 1:9900 LARKIN RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:CA
Practice Address - Zip Code:95953-2442
Practice Address - Country:US
Practice Address - Phone:530-695-1892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice