Provider Demographics
NPI:1770666562
Name:HARRIS, CHARLES R JR (DDSFAGD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:DDSFAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-0375
Mailing Address - Country:US
Mailing Address - Phone:804-642-4893
Mailing Address - Fax:804-642-5995
Practice Address - Street 1:2922 GEORGE WASHINGTON HIGHWAY
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072
Practice Address - Country:US
Practice Address - Phone:804-642-4893
Practice Address - Fax:804-642-5995
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA36181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice