Provider Demographics
NPI:1992926174
Name:C W CHARRON INC PS
Entity type:Organization
Organization Name:C W CHARRON INC PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VALLAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-383-3001
Mailing Address - Street 1:725 ST HELENS AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3705
Mailing Address - Country:US
Mailing Address - Phone:253-383-3001
Mailing Address - Fax:253-383-4810
Practice Address - Street 1:725 ST HELENS AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3705
Practice Address - Country:US
Practice Address - Phone:253-383-3001
Practice Address - Fax:253-383-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty