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General NPI Number Information
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NPI Number | 1225118300
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Entity Type | Organization
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Legal Business Name | CHARLES E. RADER, D.D.S.
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 805 E MOCKINGBIRD LN SUITE A
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City | VICTORIA
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State | TX
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Zip | 77904-2145
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Country | US
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Telephone | 361-576-5155
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Fax | 361-576-1613
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Provider Business Mailing Address
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Address Line | 805 E MOCKINGBIRD LN SUITE A
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City | VICTORIA
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State | TX
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Zip | 77904-2145
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Country | US
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Telephone | 361-576-5155
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Fax | 361-576-1613
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHARLES E RADER
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Credential | D.D.S.
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Telephone | 361-576-5155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 11676
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License Number State | TX
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