Provider Demographics
NPI:1316086721
Name:PUGLISI, CHARLES J (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:PUGLISI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2726
Mailing Address - Country:US
Mailing Address - Phone:516-378-1551
Mailing Address - Fax:516-378-1589
Practice Address - Street 1:1785 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2726
Practice Address - Country:US
Practice Address - Phone:516-378-1551
Practice Address - Fax:516-378-1589
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist