Provider Demographics
NPI:1386640704
Name:FELTS, CHARLES BAKER III (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BAKER
Last Name:FELTS
Suffix:III
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1121
Mailing Address - Country:US
Mailing Address - Phone:423-756-2450
Mailing Address - Fax:
Practice Address - Street 1:102 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1121
Practice Address - Country:US
Practice Address - Phone:423-756-2450
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist