Healthcare Provider Details

I. General information

NPI: 1700982063
Provider Name (Legal Business Name): CHARLES KENT CABANISS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 DENBIGH BOULEVARD BUILDING 7 SUITE D
NEWPORT NEWS VI
23608
US

IV. Provider business mailing address

710 DENBIGH BOULEVARD BUILDING 7 SUITE D
NEWPORT NEWS VI
23608
US

V. Phone/Fax

Practice location:
  • Phone: 757-877-9325
  • Fax: 757-874-2466
Mailing address:
  • Phone: 757-877-9325
  • Fax: 757-874-2466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401007048
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0438000032
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: