Provider Demographics
NPI:1215286844
Name:YEATER, CHARLES LAWRECE W (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:LAWRECE W
Last Name:YEATER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:WESLEY
Other - Last Name:YEATER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3015 DUDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1817
Mailing Address - Country:US
Mailing Address - Phone:304-428-6495
Mailing Address - Fax:304-865-0802
Practice Address - Street 1:3015 DUDLEY AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1817
Practice Address - Country:US
Practice Address - Phone:304-428-6495
Practice Address - Fax:304-865-0802
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV34601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice