Provider Demographics
NPI:1760638365
Name:CHARLES W JANES DDS PC
Entity Type:Organization
Organization Name:CHARLES W JANES DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:JANES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-221-3360
Mailing Address - Street 1:501 CLINIC RD
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-3605
Mailing Address - Country:US
Mailing Address - Phone:573-221-3360
Mailing Address - Fax:573-221-1472
Practice Address - Street 1:501 CLINIC RD
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3605
Practice Address - Country:US
Practice Address - Phone:573-221-3360
Practice Address - Fax:573-221-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0152961223G0001X
MODE0157021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty