Provider Demographics
NPI:1285771352
Name:DYER, CHARLES E IV (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:DYER
Suffix:IV
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16316 SPRING CYPRESS
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429
Mailing Address - Country:US
Mailing Address - Phone:281-304-9911
Mailing Address - Fax:281-304-9930
Practice Address - Street 1:16316 SPRING CYPRESS
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429
Practice Address - Country:US
Practice Address - Phone:281-304-9911
Practice Address - Fax:281-304-9930
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211741223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics