Provider Demographics
NPI:1467668962
Name:ATKINS, CHARLES RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RICHARD
Last Name:ATKINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:ATKINS'
Other - Last Name:DENTISTRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS LLC
Mailing Address - Street 1:7059 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8112
Mailing Address - Country:US
Mailing Address - Phone:225-928-4262
Mailing Address - Fax:225-928-3655
Practice Address - Street 1:7059 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8112
Practice Address - Country:US
Practice Address - Phone:225-928-4262
Practice Address - Fax:225-928-3655
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA3255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist