Provider Demographics
NPI:1285777920
Name:DABNEY, CHARLES WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:DABNEY
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 1:13321 MIDLOTHIAN TPKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4270
Mailing Address - Country:US
Mailing Address - Phone:804-794-8943
Mailing Address - Fax:804-794-7838
Practice Address - Street 1:13321 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE A
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4270
Practice Address - Country:US
Practice Address - Phone:804-794-8943
Practice Address - Fax:804-794-7838
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010056811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9179556Medicaid