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General NPI Number Information
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NPI Number | 1831200435
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Entity Type | Individual
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Provider Name | CHARLES KEELER PAXSON DMD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 931 N MAIN STREET SUITE A3
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City | PLEASANTVILLE
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State | NJ
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Zip | 08232
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Country | US
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Telephone | 609-646-3890
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Fax | 609-646-3751
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Provider Business Mailing Address
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Address Line | 814 NEW YORK AVE
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City | ABSECON
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State | NJ
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Zip | 08201
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Country | US
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Telephone | 609-646-3434
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Fax | 609-646-5151
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 22D100884400
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License Number State | NJ
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