Provider Demographics
NPI:1548082951
Name:STAMITOLES, CHARLES EMMANUEL JR (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EMMANUEL
Last Name:STAMITOLES
Suffix:JR
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 1:5640 SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8573
Mailing Address - Country:US
Mailing Address - Phone:850-549-5986
Mailing Address - Fax:
Practice Address - Street 1:1025 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7031
Practice Address - Country:US
Practice Address - Phone:850-549-5986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN296591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice