Provider Demographics
NPI:1538227145
Name:ANZALONE, CHARLES L SR (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:ANZALONE
Suffix:SR
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 1:725 N AVE K
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526
Mailing Address - Country:US
Mailing Address - Phone:337-783-2455
Mailing Address - Fax:337-783-3815
Practice Address - Street 1:725 N AVE K
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526
Practice Address - Country:US
Practice Address - Phone:337-783-2455
Practice Address - Fax:337-783-3815
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA35221223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223E0200XDental ProvidersDentistEndodontics
Not Answered1223G0001XDental ProvidersDentistGeneral Practice