Provider Demographics
NPI:1487724613
Name:CHARLES W FLUME DDS SC
Entity type:Organization
Organization Name:CHARLES W FLUME DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FLUME
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-786-0909
Mailing Address - Street 1:1403 WATERLOO AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669
Mailing Address - Country:US
Mailing Address - Phone:608-786-0909
Mailing Address - Fax:608-788-0767
Practice Address - Street 1:1403 WATERLOO AVE
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669
Practice Address - Country:US
Practice Address - Phone:608-786-0909
Practice Address - Fax:608-788-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty