Provider Demographics
NPI:1043451263
Name:CHARLES L. OAKES, D.D.S., INC.
Entity Type:Organization
Organization Name:CHARLES L. OAKES, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:OAKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-285-7377
Mailing Address - Street 1:315 N GALLOWAY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-4362
Mailing Address - Country:US
Mailing Address - Phone:972-285-7377
Mailing Address - Fax:972-329-6144
Practice Address - Street 1:315 N GALLOWAY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-4362
Practice Address - Country:US
Practice Address - Phone:972-285-7377
Practice Address - Fax:972-329-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196819001Medicaid
TX196821601Medicaid