Provider Demographics
NPI:1366652323
Name:WESTON, CHARLES
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:WESTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 SUMMERWOOD WAY
Practice Address - Street 2:SUITE C
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7713
Practice Address - Country:US
Practice Address - Phone:803-649-1771
Practice Address - Fax:803-641-1311
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics