Healthcare Provider Details

I. General information

NPI: 1588761506
Provider Name (Legal Business Name): CHARLES JOSEPH SOBERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58144 GRATIOT SUITE #316
NEW HAVEN MI
48048
US

IV. Provider business mailing address

PO BOX 46128
MT CLEMENS MI
48046
US

V. Phone/Fax

Practice location:
  • Phone: 586-749-3333
  • Fax:
Mailing address:
  • Phone: 586-465-3936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901010366
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: