Provider Demographics
NPI:1649711763
Name:CHARLES L. SMITH DDS PLLC
Entity type:Organization
Organization Name:CHARLES L. SMITH DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-342-7272
Mailing Address - Street 1:100 KANAWHA BLVD W
Mailing Address - Street 2:STE 201
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-2300
Mailing Address - Country:US
Mailing Address - Phone:304-342-7272
Mailing Address - Fax:304-344-4132
Practice Address - Street 1:100 KANAWHA BLVD W
Practice Address - Street 2:STE 201
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2300
Practice Address - Country:US
Practice Address - Phone:304-342-7272
Practice Address - Fax:304-344-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty