Provider Demographics
NPI:1750420998
Name:SOSTOWSKI, CHARLES MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:SOSTOWSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:MICHAEL
Other - Last Name:SOSTOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1550 VESTAL PARKWAY EAST
Mailing Address - Street 2:PARKWAY ROW
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1819
Mailing Address - Country:US
Mailing Address - Phone:607-786-4423
Mailing Address - Fax:607-786-4449
Practice Address - Street 1:1550 VESTAL PARKWAY EAST
Practice Address - Street 2:PARKWAY ROW
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1819
Practice Address - Country:US
Practice Address - Phone:607-786-4423
Practice Address - Fax:607-786-4449
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY372331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY37233OtherDENTIST