Provider Demographics
NPI:1780756809
Name:AYCOCK, CHARLES BRANTLEY III (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRANTLEY
Last Name:AYCOCK
Suffix:III
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 1:417 WEST 8TH STREET
Mailing Address - Street 2:APT D
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-1400
Mailing Address - Country:US
Mailing Address - Phone:704-517-3013
Mailing Address - Fax:216-593-7533
Practice Address - Street 1:417 WEST 8TH STREET
Practice Address - Street 2:APT D
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1400
Practice Address - Country:US
Practice Address - Phone:704-517-3013
Practice Address - Fax:216-593-7533
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice