Provider Demographics
NPI:1427266295
Name:ETHEREDGE, CHARLES HILL (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HILL
Last Name:ETHEREDGE
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 1:3365 BURNS RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4326
Mailing Address - Country:US
Mailing Address - Phone:561-627-9056
Mailing Address - Fax:561-625-0910
Practice Address - Street 1:3365 BURNS RD
Practice Address - Street 2:SUITE 212
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4326
Practice Address - Country:US
Practice Address - Phone:561-627-9056
Practice Address - Fax:561-625-0910
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 15646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist