Provider Demographics
NPI:1285729285
Name:BOATNER, CHARLES KNOX (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:KNOX
Last Name:BOATNER
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 1:1760 RUFE SNOW DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5628
Mailing Address - Country:US
Mailing Address - Phone:817-498-3889
Mailing Address - Fax:817-281-2810
Practice Address - Street 1:1760 RUFE SNOW DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5628
Practice Address - Country:US
Practice Address - Phone:817-498-3889
Practice Address - Fax:817-281-2810
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208641223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice