Healthcare Provider Details

I. General information

NPI: 1154241164
Provider Name (Legal Business Name): CHARLES CLAYTON RHOADES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 WHITAKER RD
WINSTON SALEM NC
27106-4823
US

IV. Provider business mailing address

1086 WHITAKER RD
WINSTON SALEM NC
27106-4823
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-9247
  • Fax:
Mailing address:
  • Phone: 336-765-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14908
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: