Provider Demographics
NPI:1689831125
Name:VAN METER, CHARLES JACKSON III (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JACKSON
Last Name:VAN METER
Suffix:III
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MAXEY DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042
Mailing Address - Country:US
Mailing Address - Phone:601-665-0411
Mailing Address - Fax:
Practice Address - Street 1:300 MAXEY DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2576
Practice Address - Country:US
Practice Address - Phone:601-665-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58531223S0112X
MS0S466-131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery