Provider Demographics
NPI:1154590321
Name:MAUPIN, CHARLES THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
Last Name:MAUPIN
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 1:3233 63RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5742
Mailing Address - Country:US
Mailing Address - Phone:806-589-3390
Mailing Address - Fax:806-686-0979
Practice Address - Street 1:3233 63RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5742
Practice Address - Country:US
Practice Address - Phone:806-589-3390
Practice Address - Fax:806-686-0979
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist