Provider Demographics
NPI:1417260936
Name:DAVIS, CHARLES A JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:DAVIS
Suffix:JR
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 1:716 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4506
Mailing Address - Country:US
Mailing Address - Phone:520-591-9107
Mailing Address - Fax:
Practice Address - Street 1:303 S BOULEVARD
Practice Address - Street 2:APT 10
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-5769
Practice Address - Country:US
Practice Address - Phone:520-591-9107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0442000130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0442000130OtherVA LICENCE