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General NPI Number Information
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NPI Number | 1053581470
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Entity Type | Organization
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Legal Business Name | CHARLES K. DAHLGREN, M.D., CORP
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 1995 ERRECART BLVD STE 109
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City | ELKO
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State | NV
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Zip | 89801-8336
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Country | US
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Telephone | 775-738-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 1995 ERRECART BLVD STE 109
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City | ELKO
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State | NV
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Zip | 89801-8336
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Country | US
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Telephone | 775-738-2555
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES KENNETH DAHLGREN
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Credential | MD
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Telephone | 775-738-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number |
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License Number State |
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