Provider Demographics
NPI:1720194384
Name:CHARLESTON, GAIL YVONNE (DDS)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:YVONNE
Last Name:CHARLESTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:GAIL
Other - Middle Name:CHARLESTON
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2998 PANOLA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038
Mailing Address - Country:US
Mailing Address - Phone:770-322-8040
Mailing Address - Fax:770-322-3024
Practice Address - Street 1:2998 PANOLA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038
Practice Address - Country:US
Practice Address - Phone:770-322-8040
Practice Address - Fax:770-322-3024
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8845122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist