Provider Demographics
NPI:1487752085
Name:SMITH, CHARLES LESTER (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LESTER
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KANAWHA BLVD W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302
Mailing Address - Country:US
Mailing Address - Phone:304-342-7272
Mailing Address - Fax:304-344-4132
Practice Address - Street 1:1501 7TH AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25312
Practice Address - Country:US
Practice Address - Phone:304-343-9131
Practice Address - Fax:304-343-2416
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0137214000Medicaid