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NPI Code Detail

MEDICARE: DR. CHARLES BAKER FELTS IV D.D.S.

MEDICARE: DR. CHARLES BAKER FELTS IV D.D.S.
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
11223S0112XOral and Maxillofacial Surgery (Dentist)DS0000010713TN
2204E00000XOral & Maxillofacial Surgery (D.M.D.)DS0000010713TN

General Provider Information

NPI Number : 1720472855
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES BAKER FELTS IV D.D.S.
Provider Business Mailing Address
First Line : 901 RIVERFRONT PKWY STE 202
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37402-2193
Country : US
Telephone Number : 423-541-5700
Fax Number : 423-541-5705
Provider Business Practice Location Address
First Line : 901 RIVERFRONT PKWY STE 202
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37402-2193
Country : US
Telephone Number : 423-541-5700
Fax Number : 423-541-5705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2015
Last Update Date : 05/28/2025

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