Provider Demographics
NPI:1306979182
Name:ARAGON, CHARLES DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
Last Name:ARAGON
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 1:832 SO GREVILLEA AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301
Mailing Address - Country:US
Mailing Address - Phone:310-419-3033
Mailing Address - Fax:310-419-4621
Practice Address - Street 1:832 SO GREVILLEA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301
Practice Address - Country:US
Practice Address - Phone:310-419-3033
Practice Address - Fax:310-419-4621
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist