Provider Demographics
NPI:1083988265
Name:CHARLES E, DYER III DDS
Entity Type:Organization
Organization Name:CHARLES E, DYER III DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:DYER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:409-898-8923
Mailing Address - Street 1:1120 LONGFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4845
Mailing Address - Country:US
Mailing Address - Phone:409-989-8923
Mailing Address - Fax:409-892-1960
Practice Address - Street 1:1120 LONGFELLOW DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-4845
Practice Address - Country:US
Practice Address - Phone:409-989-8923
Practice Address - Fax:409-892-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090898001Medicaid