Healthcare Provider Details

I. General information

NPI: 1053835017
Provider Name (Legal Business Name): CHARLES W. ELWELL III DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N MILLS AVE
ARCADIA FL
34266-8811
US

IV. Provider business mailing address

1020 N MILLS AVE
ARCADIA FL
34266-8811
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-6116
  • Fax: 813-441-8032
Mailing address:
  • Phone: 863-494-6116
  • Fax: 813-441-8032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN27728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: