Individual
DR. CHARLES RANDALL STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
201 CHERRY DR, CHERAW, SC 29520
(843) 537-2415
(843) 537-7889
Mailing address
201 CHERRY DR, CHERAW, SC 29520
(843) 537-2415
(843) 537-7889
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2893
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z28934
—
SC
Enumeration date
05/22/2006
Last updated
04/14/2014
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