MEDICARE: DR. MARIE-LOURDES CHARLES DDS

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	031676-1	NY

General Provider Information

NPI Number	:	1568588648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE-LOURDES CHARLES DDS

Provider Business Mailing Address
First Line	:	141 ELMWOOD AVE
Second Line	:
City	:	HEMPSTEAD
State	:	NY
Zip	:	11550-6508
Country	:	US
Telephone Number	:	516-292-9684
Fax Number	:	718-284-1008

Provider Business Practice Location Address
First Line	:	498 E 35TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5512
Country	:	US
Telephone Number	:	718-284-3671
Fax Number	:	718-284-1008

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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