Provider Demographics
NPI:1538341888
Name:PUTNAM, CHARLES JASON (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JASON
Last Name:PUTNAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CLARK SUMMIT DR
Mailing Address - Street 2:SUITE 202 BOX 9
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4205
Mailing Address - Country:US
Mailing Address - Phone:843-837-8585
Mailing Address - Fax:843-837-8587
Practice Address - Street 1:25 CLARK SUMMIT DR
Practice Address - Street 2:SUITE 202 BOX 9
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4205
Practice Address - Country:US
Practice Address - Phone:843-837-8585
Practice Address - Fax:843-837-8587
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42261223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics