Healthcare Provider Details

I. General information

NPI: 1972575686
Provider Name (Legal Business Name): CHARLENE MELISSA AULD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 CRAVEN ST
SAN DIEGO CA
92136-5596
US

IV. Provider business mailing address

10539 ABALONE LANDING TER
SAN DIEGO CA
92130-8711
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-8252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number31036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: