Provider Demographics
NPI:1104954387
Name:CHARLES E GUEST DDS PC
Entity type:Organization
Organization Name:CHARLES E GUEST DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GUEST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-247-2151
Mailing Address - Street 1:2975 FORT HENRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664
Mailing Address - Country:US
Mailing Address - Phone:423-247-2151
Mailing Address - Fax:423-247-1594
Practice Address - Street 1:2975 FORT HENRY DRIVE
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664
Practice Address - Country:US
Practice Address - Phone:423-247-2151
Practice Address - Fax:423-247-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1893 & 7139OtherDRS LICENSE #S
TN=========OtherTAX ID #