Provider Demographics
NPI:1730476060
Name:RATCLIFF, CHARLES DAVID (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
Last Name:RATCLIFF
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E LAYFAIR DR STE 120
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7604
Mailing Address - Country:US
Mailing Address - Phone:601-664-1855
Mailing Address - Fax:601-664-1856
Practice Address - Street 1:201 E LAYFAIR DR STE 120
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7604
Practice Address - Country:US
Practice Address - Phone:601-664-1855
Practice Address - Fax:601-664-1856
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSENDO-491-141223E0200X
MS3603-11122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist