MEDICARE: DR. CHARLES LESTER SMITH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2700	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487752085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES LESTER SMITH DDS

Provider Business Mailing Address
First Line	:	100 KANAWHA BLVD W
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25302
Country	:	US
Telephone Number	:	304-342-7272
Fax Number	:	304-344-4132

Provider Business Practice Location Address
First Line	:	1501 7TH AVE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25312
Country	:	US
Telephone Number	:	304-343-9131
Fax Number	:	304-343-2416

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/15/2014

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