Provider Demographics
NPI:1316907538
Name:GRELLE, CHARLES E (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:GRELLE
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 1:1265 GRAHAM RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8018
Mailing Address - Country:US
Mailing Address - Phone:314-839-5900
Mailing Address - Fax:314-839-3133
Practice Address - Street 1:1265 GRAHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8018
Practice Address - Country:US
Practice Address - Phone:314-839-5900
Practice Address - Fax:314-839-3133
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice