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General NPI Number Information
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NPI Number | 1225150964
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Entity Type | Organization
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Legal Business Name | CHARLES DUNLAP, DDS
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 78 ALAMAR ST
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-7303
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Country | US
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Telephone | 706-858-7054
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Fax | 706-858-7017
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Provider Business Mailing Address
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Address Line | 78 ALAMAR ST
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-7303
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Country | US
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Telephone | 706-858-7054
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Fax | 706-858-7017
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES IRVINE DUNLAP
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Credential | D.D.S.
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Telephone | 706-858-7054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | DN009850
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License Number State | GA
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