Provider Demographics
NPI:1205970621
Name:CLATER, CHARLES ROLAND JR (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROLAND
Last Name:CLATER
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 1:24B JOHN MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3214
Mailing Address - Country:US
Mailing Address - Phone:540-347-5000
Mailing Address - Fax:540-347-5152
Practice Address - Street 1:24B JOHN MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3214
Practice Address - Country:US
Practice Address - Phone:540-347-5000
Practice Address - Fax:540-347-5152
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist