Provider Demographics
NPI:1588761506
Name:SOBERS, CHARLES JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:SOBERS
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:PO BOX 46128
Mailing Address - Street 2:
Mailing Address - City:MT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48046
Mailing Address - Country:US
Mailing Address - Phone:586-465-3936
Mailing Address - Fax:
Practice Address - Street 1:58144 GRATIOT
Practice Address - Street 2:SUITE #316
Practice Address - City:NEW HAVEN
Practice Address - State:MI
Practice Address - Zip Code:48048
Practice Address - Country:US
Practice Address - Phone:586-749-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901010366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4892381Medicaid