Healthcare Provider Details

I. General information

NPI: 1649929902
Provider Name (Legal Business Name): CHARLOTTE JULIETA DYER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 W SYLVANIA AVE
TOLEDO OH
43623-4467
US

IV. Provider business mailing address

3404 W SYLVANIA AVE
TOLEDO OH
43623-4480
US

V. Phone/Fax

Practice location:
  • Phone: 419-407-2663
  • Fax:
Mailing address:
  • Phone: 419-407-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34018459
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: