Provider Demographics
NPI:1427072354
Name:CLINE, CHARLES W (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:CLINE
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 1:2348 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3435
Mailing Address - Country:US
Mailing Address - Phone:281-332-3756
Mailing Address - Fax:281-332-1191
Practice Address - Street 1:2348 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3435
Practice Address - Country:US
Practice Address - Phone:281-332-3756
Practice Address - Fax:281-332-1191
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12949OtherSTATE DENTAL LISCENSE
TX12949OtherSTATE DENTAL LISCENSE