Provider Demographics
NPI:1528287950
Name:FORD, CHARLES LESTER III (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LESTER
Last Name:FORD
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7522
Mailing Address - Country:US
Mailing Address - Phone:727-327-2342
Mailing Address - Fax:727-327-5173
Practice Address - Street 1:3921 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7522
Practice Address - Country:US
Practice Address - Phone:727-327-2342
Practice Address - Fax:727-327-5173
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist