Provider Demographics
NPI:1538258637
Name:PRILLER, CHARLES AUGUST JR (DSS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:AUGUST
Last Name:PRILLER
Suffix:JR
Gender:M
Credentials:DSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 FREDERICK RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4645
Mailing Address - Country:US
Mailing Address - Phone:410-788-2800
Mailing Address - Fax:410-788-2801
Practice Address - Street 1:405 FREDERICK RD
Practice Address - Street 2:SUITE 160
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4645
Practice Address - Country:US
Practice Address - Phone:410-788-2800
Practice Address - Fax:410-788-2801
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD64421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice