MEDICARE: CHARLES ELWELL III, D.M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1558140657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES ELWELL III, D.M.D., P.A.

Provider Business Mailing Address
First Line	:	3307 CLARK RD STE 104
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-8419
Country	:	US
Telephone Number	:	941-366-8882
Fax Number	:

Provider Business Practice Location Address
First Line	:	3307 CLARK RD STE 104
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-8419
Country	:	US
Telephone Number	:	941-366-8882
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. CHARLES W ELWELL III
Credential	:	D.M.D.
Telephone Number	:	941-366-8882

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	01/30/2026

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