Healthcare Provider Details

I. General information

NPI: 1184849689
Provider Name (Legal Business Name): CHARLES A WEST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 MONTAGUE AVENUE EXTENSION UNIT 2
GREENWOOD SC
29649
US

IV. Provider business mailing address

1815 MONTAGUE AVENUE EXTENSION UNIT 2
GREENWOOD SC
29649
US

V. Phone/Fax

Practice location:
  • Phone: 864-223-8600
  • Fax:
Mailing address:
  • Phone: 864-223-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1514112
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: