Provider Demographics
NPI:1720292907
Name:MCBRAYER, CHARLES L (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:MCBRAYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5022 OLD GODSEY LANE
Mailing Address - Street 2:HAMILL PROFESSIONAL CENTRE SUITE 1
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343
Mailing Address - Country:US
Mailing Address - Phone:423-870-9567
Mailing Address - Fax:423-870-5331
Practice Address - Street 1:5022 OLD GODSEY LANE
Practice Address - Street 2:HAMILL PROFESSIONAL CENTRE SUITE 1
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343
Practice Address - Country:US
Practice Address - Phone:423-870-9567
Practice Address - Fax:423-870-9567
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN71081223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics