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General NPI Number Information
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NPI Number | 1770757478
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Entity Type | Organization
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Legal Business Name | CHARLES J. EDELEN, D.D.S., INC.
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 425 W RUSSELL RD
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City | SIDNEY
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State | OH
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Zip | 45365-1454
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Country | US
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Telephone | 937-492-2848
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Fax | 937-492-8615
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Provider Business Mailing Address
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Address Line | 425 W RUSSELL RD
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City | SIDNEY
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State | OH
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Zip | 45365-1454
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Country | US
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Telephone | 937-492-2848
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Fax | 937-492-8615
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES J EDELEN
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Credential | D.D.S.
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Telephone | 937-492-2848
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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 | 30.017977
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License Number State | OH
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