Provider Demographics
NPI:1194932533
Name:WEST, CHARLES M (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:WEST
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:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:ALTAVISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24517-0417
Mailing Address - Country:US
Mailing Address - Phone:434-369-7784
Mailing Address - Fax:434-369-7960
Practice Address - Street 1:511 7TH ST
Practice Address - Street 2:
Practice Address - City:ALTAVISTA
Practice Address - State:VA
Practice Address - Zip Code:24517-1815
Practice Address - Country:US
Practice Address - Phone:434-369-7784
Practice Address - Fax:434-369-7960
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010074621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice