Provider Demographics
NPI:1164523445
Name:CARR, CHARLES THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:THOMAS
Last Name:CARR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 W 45TH AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5084
Mailing Address - Country:US
Mailing Address - Phone:806-677-0202
Mailing Address - Fax:806-677-0205
Practice Address - Street 1:7200 W 45TH AVE
Practice Address - Street 2:STE 5
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5084
Practice Address - Country:US
Practice Address - Phone:806-677-0202
Practice Address - Fax:806-677-0205
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist