Basic Information
| Provider Information | |||||||||
| NPI: | 1083111447 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHARNAS | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | CRAIG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 COVINGTON ST | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445101617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304803195 | ||||||||
| FaxNumber: | 3304801366 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 W 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142923596 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2018 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223E0200X | 30.025374 | OH | Y | Dental Providers | Dentist | Endodontics |
ID Information
| ID | Type | State | Issuer | Description | 0291994 | 05 | OH | MEDICAID |