Provider Demographics
NPI:1285792986
Name:SARLO, CHARLES A JR (DDS, PA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:SARLO
Suffix:JR
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 BABCOCK ST NE STE 8
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4637
Mailing Address - Country:US
Mailing Address - Phone:321-984-2565
Mailing Address - Fax:321-984-2926
Practice Address - Street 1:5201 BABCOCK ST NE STE 8
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4637
Practice Address - Country:US
Practice Address - Phone:321-984-2565
Practice Address - Fax:321-984-2926
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL95201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT54871Medicare UPIN
FL60882Medicare ID - Type Unspecified