Provider Demographics
NPI:1194702753
Name:HABIB, CHARLES M (PHD,DMD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:HABIB
Suffix:
Gender:M
Credentials:PHD,DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-2642
Mailing Address - Country:US
Mailing Address - Phone:978-373-9669
Mailing Address - Fax:
Practice Address - Street 1:696 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-2642
Practice Address - Country:US
Practice Address - Phone:978-373-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist