Provider Demographics
NPI:1801019542
Name:RICHTER, CHARLES COOK JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:COOK
Last Name:RICHTER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N ST MARYS
Mailing Address - Street 2:SUITE # 130
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1747
Mailing Address - Country:US
Mailing Address - Phone:210-222-8260
Mailing Address - Fax:210-222-2461
Practice Address - Street 1:405 N ST MARYS
Practice Address - Street 2:SUITE # 130
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1747
Practice Address - Country:US
Practice Address - Phone:210-222-8260
Practice Address - Fax:210-222-2461
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK0057007OtherDPS
TXK0057007OtherDPS