Provider Demographics
NPI:1447370200
Name:DOOLITTLE, CHARLES KENDAL (DMD, PC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:KENDAL
Last Name:DOOLITTLE
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 N WEBER ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7503
Mailing Address - Country:US
Mailing Address - Phone:719-471-1900
Mailing Address - Fax:719-471-1903
Practice Address - Street 1:1705 N WEBER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7503
Practice Address - Country:US
Practice Address - Phone:719-471-1900
Practice Address - Fax:719-471-1903
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84-1252401122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02049229Medicaid