Healthcare Provider Details

I. General information

NPI: 1780786855
Provider Name (Legal Business Name): CHARLES E SAULS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E WILLINGHAM ST
SYLVESTER GA
31791-1746
US

IV. Provider business mailing address

PO BOX 390
SYLVESTER GA
31791
US

V. Phone/Fax

Practice location:
  • Phone: 229-776-6888
  • Fax: 229-776-1155
Mailing address:
  • Phone: 229-776-6888
  • Fax: 229-776-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10570
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: