MEDICARE: DR. CHARLES A ABBICK III D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	60678	KS
2	122300000X	Dentist	2009014030	MO

General Provider Information

NPI Number	:	1326271578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES A ABBICK III D.D.S.

Provider Business Mailing Address
First Line	:	625 E NORTH ST
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-2446
Country	:	US
Telephone Number	:	785-826-1546
Fax Number	:	785-826-9161

Provider Business Practice Location Address
First Line	:	625 E NORTH ST
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-2446
Country	:	US
Telephone Number	:	785-826-1546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	12/31/2009

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