Provider Demographics
NPI:1952428112
Name:WEAR, CHARLES K (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:WEAR
Suffix:
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 1:1880 SONOMA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4953
Mailing Address - Country:US
Mailing Address - Phone:707-546-8600
Mailing Address - Fax:707-546-0166
Practice Address - Street 1:1880 SONOMA AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4953
Practice Address - Country:US
Practice Address - Phone:707-546-8600
Practice Address - Fax:707-546-0166
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA209621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68-0376185OtherTIN