Healthcare Provider Details

I. General information

NPI: 1831306349
Provider Name (Legal Business Name): CHARLES GENTRY DAVIS JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 S HANLEY RD
SAINT LOUIS MO
63144-2905
US

IV. Provider business mailing address

1819 S HANLEY RD
SAINT LOUIS MO
63144-2905
US

V. Phone/Fax

Practice location:
  • Phone: 314-818-3201
  • Fax:
Mailing address:
  • Phone: 314-708-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019-020774
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number015355
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: