Provider Demographics
NPI:1144311630
Name:SCHOLLER, CHARLES EDWARD III (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:SCHOLLER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:SOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:93066-0608
Mailing Address - Country:US
Mailing Address - Phone:805-386-3199
Mailing Address - Fax:805-386-4089
Practice Address - Street 1:3265 SOMIS RD.
Practice Address - Street 2:
Practice Address - City:SOMIS
Practice Address - State:CA
Practice Address - Zip Code:93066-0608
Practice Address - Country:US
Practice Address - Phone:805-386-3199
Practice Address - Fax:805-386-4089
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA333681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice