MEDICARE: DR. CHARLES WILLIAM DREXLER D.D.S.

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	25613	FL
2	122300000X	Dentist	25613	FL
3	122300000X	Dentist	28904	TX

General Provider Information

NPI Number	:	1881032993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES WILLIAM DREXLER D.D.S.

Provider Business Mailing Address
First Line	:	7500 21ST ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33702-4820
Country	:	US
Telephone Number	:	972-213-5446
Fax Number	:

Provider Business Practice Location Address
First Line	:	4315 HENDERSON BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5612
Country	:	US
Telephone Number	:	813-358-7110
Fax Number	:

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

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	10/26/2023

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