Provider Demographics
NPI:1326259367
Name:CHARLES E. HARRIS DDS, PC
Entity Type:Organization
Organization Name:CHARLES E. HARRIS DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-951-3989
Mailing Address - Street 1:210 PROFESSIONAL PARK DR SE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6680
Mailing Address - Country:US
Mailing Address - Phone:540-951-3989
Mailing Address - Fax:540-951-0273
Practice Address - Street 1:210 PROFESSIONAL PARK DR SE
Practice Address - Street 2:SUITE 11
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6680
Practice Address - Country:US
Practice Address - Phone:540-951-3989
Practice Address - Fax:540-951-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010055201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA067063OtherANTHEM PROVIDER NUMBER
VA0401005520Medicare UPIN