Provider Demographics
NPI:1053764589
Name:CHARLES R. ANDEREGG, JR., DDS
Entity type:Organization
Organization Name:CHARLES R. ANDEREGG, JR., DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDEREGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-747-7007
Mailing Address - Street 1:14655 BEL RED RD
Mailing Address - Street 2:202
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3900
Mailing Address - Country:US
Mailing Address - Phone:425-747-7007
Mailing Address - Fax:425-747-7342
Practice Address - Street 1:14655 BEL RED RD
Practice Address - Street 2:202
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3900
Practice Address - Country:US
Practice Address - Phone:425-747-7007
Practice Address - Fax:425-747-7342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty