Healthcare Provider Details

I. General information

NPI: 1649280322
Provider Name (Legal Business Name): CHARLES RAY FRENCH II DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46161 WESTLAKE DR #220
POTOMAC FALLS VA
20165-5871
US

IV. Provider business mailing address

5282 POND MOUNTAIN RD
BROAD RUN VA
20137-2027
US

V. Phone/Fax

Practice location:
  • Phone: 703-430-1212
  • Fax:
Mailing address:
  • Phone: 540-351-0558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401006035
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: