MEDICARE: CHARLES DAREN CARLILE 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	7008	CO

General Provider Information

NPI Number	:	1780684134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES DAREN CARLILE DMD

Provider Business Mailing Address
First Line	:	12157 W COOPER DR
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80127-4861
Country	:	US
Telephone Number	:	303-973-6797
Fax Number	:	303-933-5897

Provider Business Practice Location Address
First Line	:	6901 S PIERCE ST
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80128-7202
Country	:	US
Telephone Number	:	303-973-1900
Fax Number	:	303-933-5897

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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