Healthcare Provider Details

I. General information

NPI: 1487724613
Provider Name (Legal Business Name): CHARLES W FLUME DDS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 WATERLOO AVE
WEST SALEM WI
54669
US

IV. Provider business mailing address

1403 WATERLOO AVE
WEST SALEM WI
54669
US

V. Phone/Fax

Practice location:
  • Phone: 608-786-0909
  • Fax: 608-788-0767
Mailing address:
  • Phone: 608-786-0909
  • Fax: 608-788-0767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: CHARLES WILLIAM FLUME SR.
Title or Position: OWNER
Credential: DDS
Phone: 608-786-0909