MEDICARE: DR. CHARLES W. ELWELL III DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN27728	FL

General Provider Information

NPI Number	:	1053835017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES W. ELWELL III DMD

Provider Business Mailing Address
First Line	:	3307 CLARK RD STE 104
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-8419
Country	:	US
Telephone Number	:	941-366-8882
Fax Number	:

Provider Business Practice Location Address
First Line	:	3307 CLARK RD STE 104
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-8419
Country	:	US
Telephone Number	:	941-366-8882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2017
Last Update Date	:	01/30/2026

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1558140657 — CHARLES ELWELL III, D.M.D., P.A.
Practice Location Address:

3307 CLARK RD STE 104
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