Healthcare Provider Details

I. General information

NPI: 1801995857
Provider Name (Legal Business Name): CHARLES ROBERT AVRUTIK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 RIDGE RD DAYTON PROFESSIONAL CENTER, SUITE 5
DAYTON NJ
08810-1398
US

IV. Provider business mailing address

395 RIDGE RD DAYTON PROFESSIONAL CENTER, SUITE 5
DAYTON NJ
08810-1398
US

V. Phone/Fax

Practice location:
  • Phone: 732-274-2544
  • Fax: 732-274-2188
Mailing address:
  • Phone: 732-274-2544
  • Fax: 732-274-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI01260600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: