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General NPI Number Information
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NPI Number | 1245410232
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Entity Type | Organization
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Legal Business Name | CHARLES CLAUSEN DDS PC
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 13055 W MCDOWELL #G103
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City | AVONDALE
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State | AZ
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Zip | 85392
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Country | US
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Telephone | 623-848-0100
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Fax | 623-848-3516
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Provider Business Mailing Address
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Address Line | 13055 W MCDOWELL #G103
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City | AVONDALE
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State | AZ
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Zip | 85392
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Country | US
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Telephone | 623-848-0100
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Fax | 623-848-3516
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Authorized Official
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Title or Position | MANAGER
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Name | THERESA M WHITE
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Credential |
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Telephone | 623-848-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3245
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License Number State | AZ
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