Provider Demographics
NPI:1821262304
Name:CHARLES D PAYET DDS PA
Entity Type:Organization
Organization Name:CHARLES D PAYET DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:PAYET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-364-7069
Mailing Address - Street 1:4601 PARK RD STE 175
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2297
Mailing Address - Country:US
Mailing Address - Phone:704-364-7069
Mailing Address - Fax:704-364-7036
Practice Address - Street 1:4601 PARK RD STE 175
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2297
Practice Address - Country:US
Practice Address - Phone:704-364-7069
Practice Address - Fax:704-364-7036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6856122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty