| NPI | 1447196746 |
|---|---|
| Doing Business As | CHARLES STREET FAMILY DENTISTRY |
| Doing Business As | ORLAND PARK |
| Entity Type | Organization |
| Authorized Contact | JOE SHIPPEE Credentialing Manager 904-472-3839 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2026-04-28 |
| Last Update Date | 2026-04-28 |