=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285078907
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES FREDERICK STRECKFUS D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2013
-----------------------------------------------------
Last Update Date | 04/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1941 EAST RD ROOM 5322
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-6010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-486-4531
-----------------------------------------------------
Fax | 713-486-0450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1941 EAST RD ROOM 5322
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-6010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-486-4531
-----------------------------------------------------
Fax | 713-486-0450
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | F-22578
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------