Healthcare Provider Details

I. General information

NPI: 1346282829
Provider Name (Legal Business Name): CHARLES BRENT WOFFINDEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

2832 E DOWNING CIR
MESA AZ
85213-6929
US

V. Phone/Fax

Practice location:
  • Phone: 602-222-6424
  • Fax:
Mailing address:
  • Phone: 480-924-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4101
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number03899
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: