Basic Information
| Provider Information | |||||||||
| NPI: | 1952671539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHARLES | ||||||||
| FirstName: | BERNADETTE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DHAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 310 | ||||||||
| Address2: | |||||||||
| City: | ST. MARY'S | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074383500 | ||||||||
| FaxNumber: | 9074383540 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 HOSPITAL ROAD | ||||||||
| Address2: | |||||||||
| City: | ST. MARY'S | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074383500 | ||||||||
| FaxNumber: | 9074383540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2012 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 126800000X | Y | Dental Providers | Dental Assistant |
No ID Information.