Provider Demographics
NPI:1033257159
Name:DOBECK, CHARLES RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:DOBECK
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 1:1243 7TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1605
Mailing Address - Country:US
Mailing Address - Phone:310-451-5348
Mailing Address - Fax:310-656-2565
Practice Address - Street 1:1243 7TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1605
Practice Address - Country:US
Practice Address - Phone:310-451-5348
Practice Address - Fax:310-656-2565
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB28146-01Medicaid