Provider Demographics
NPI:1215814330
Name:DONG, CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:DONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9727
Mailing Address - Country:US
Mailing Address - Phone:706-386-9075
Mailing Address - Fax:
Practice Address - Street 1:2550 SANDY PLAINS RD STE 145
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7221
Practice Address - Country:US
Practice Address - Phone:770-321-2755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist