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General NPI Number Information
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NPI Number | 1871819292
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Entity Type | Organization
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Legal Business Name | CHARLES R PAYERLE, DDS, MD, PLLC
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Dates
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Enumeration Date | 04/09/2010
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Last Update Date | 04/09/2010
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Provider Practice Location Address
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Address Line | 12001 SOUTH FWY SUITE 207
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City | BURLESON
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State | TX
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Zip | 76028-7208
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Country | US
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Telephone | 817-568-6811
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Fax | 817-568-6813
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Provider Business Mailing Address
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Address Line | 12001 SOUTH FWY SUITE 207
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City | BURLESON
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State | TX
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Zip | 76028-7208
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Country | US
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Telephone | 817-568-6811
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Fax | 817-568-6813
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES R PAYERLE
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Credential | DDS, MD, LLC
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Telephone | 817-568-6811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0023735
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License Number State | TX
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