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NPI Code Detail

MEDICARE: CHARLES ALBERT WORTON DDS

MEDICARE:   CHARLES ALBERT WORTON  DDS
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
11223P0300XPeriodontics12149OH

General Provider Information

NPI Number : 1801994108
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES ALBERT WORTON DDS
Provider Business Mailing Address
First Line : 6363 YORK ROAD
Second Line : SUITE 203
City : PARMA HEIGHTS
State : OH
Zip : 44130-3031
Country : US
Telephone Number : 440-888-5111
Fax Number : 440-888-5112
Provider Business Practice Location Address
First Line : 6363 YORK ROAD
Second Line : SUITE 203
City : PARMA HEIGHTS
State : OH
Zip : 44130-3031
Country : US
Telephone Number : 440-888-5111
Fax Number : 440-888-5112
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/08/2007

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Directions to “ CHARLES ALBERT WORTON DDS” Practice Location

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