Provider Demographics
NPI:1205974078
Name:CHARLES P FENELL DDS MS INC
Entity type:Organization
Organization Name:CHARLES P FENELL DDS MS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:P
Authorized Official - Last Name:FENELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:216-291-9473
Mailing Address - Street 1:4568 MAYFIELD RD
Mailing Address - Street 2:SUITE #203
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4064
Mailing Address - Country:US
Mailing Address - Phone:216-291-9473
Mailing Address - Fax:216-691-4110
Practice Address - Street 1:4568 MAYFIELD RD
Practice Address - Street 2:SUITE #203
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4064
Practice Address - Country:US
Practice Address - Phone:216-291-9473
Practice Address - Fax:216-691-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH146621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty