Provider Demographics
NPI:1407092935
Name:CHARLES E. DYER IV, DDS, MS, PC
Entity Type:Organization
Organization Name:CHARLES E. DYER IV, DDS, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DYER
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:281-304-9911
Mailing Address - Street 1:13611 SKINNER RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1018
Mailing Address - Country:US
Mailing Address - Phone:281-304-9911
Mailing Address - Fax:281-304-9930
Practice Address - Street 1:13611 SKINNER ROAD
Practice Address - Street 2:SUITE 230
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429
Practice Address - Country:US
Practice Address - Phone:281-304-9911
Practice Address - Fax:281-304-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211741223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty