Provider Demographics
NPI:1780704270
Name:BANKS, CHARLES H JR (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:BANKS
Suffix:JR
Gender:M
Credentials:DMD
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 298
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-0298
Mailing Address - Country:US
Mailing Address - Phone:205-486-8601
Mailing Address - Fax:205-486-9183
Practice Address - Street 1:2095 20TH AVENUE
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565
Practice Address - Country:US
Practice Address - Phone:205-486-8601
Practice Address - Fax:205-486-9183
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice