Provider Demographics
NPI:1710017231
Name:CHARLES, WILFRED A (DDS)
Entity type:Individual
Prefix:DR
First Name:WILFRED
Middle Name:A
Last Name:CHARLES
Suffix:
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 1:12503 PLEASANT PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2520
Mailing Address - Country:US
Mailing Address - Phone:301-249-6847
Mailing Address - Fax:
Practice Address - Street 1:1300 CARAWAY CT STE 105
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5462
Practice Address - Country:US
Practice Address - Phone:301-925-7990
Practice Address - Fax:301-925-7449
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD66501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice