Provider Demographics
NPI:1366531949
Name:BETTS, CHARLES FARRAR JR (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FARRAR
Last Name:BETTS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:BETTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2012 DANVILLE PARK DR SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1832
Mailing Address - Country:US
Mailing Address - Phone:256-350-5006
Mailing Address - Fax:256-351-2020
Practice Address - Street 1:2012 DANVILLE PARK DR SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1832
Practice Address - Country:US
Practice Address - Phone:256-350-5006
Practice Address - Fax:256-351-2020
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice