Provider Demographics
NPI:1801945530
Name:CHARLES, TRYPHOSE (DMD)
Entity type:Individual
Prefix:
First Name:TRYPHOSE
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15509 N SCOTTSDALE RD UNIT 1047
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3107
Mailing Address - Country:US
Mailing Address - Phone:203-550-0996
Mailing Address - Fax:
Practice Address - Street 1:3030 N 67TH PL UNIT 126
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6082
Practice Address - Country:US
Practice Address - Phone:480-359-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0080391223G0001X
AZ0099081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice