Provider Demographics
NPI:1043421886
Name:TABB, CHARLES H (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:TABB
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 1:1001 CROMWELL BRIDGE ROAD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3331
Mailing Address - Country:US
Mailing Address - Phone:410-339-7077
Mailing Address - Fax:
Practice Address - Street 1:1001 CROMWELL BRIDGE ROAD
Practice Address - Street 2:SUITE 314
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3331
Practice Address - Country:US
Practice Address - Phone:410-339-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD107691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice