Healthcare Provider Details

I. General information

NPI: 1669477758
Provider Name (Legal Business Name): CHARLES FRANK MASSLER JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF DENTISTRY, WFUSM MEDICAL CENTER BOULEVARD
WINSTON-SALEM NC
27157-1093
US

IV. Provider business mailing address

DEPARTMENT OF DENTISTRY, WFUSM MEDICAL CENTER BOULEVARD
WINSTON-SALEM NC
27157-1093
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2164
  • Fax: 336-716-9045
Mailing address:
  • Phone: 336-716-2164
  • Fax: 336-716-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6941
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401008230
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number012950
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: