Provider Demographics
NPI:1063444750
Name:VERBANIC, CHARLES ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROBERT
Last Name:VERBANIC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:127 CHURCHILL HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1386
Mailing Address - Country:US
Mailing Address - Phone:330-759-4550
Mailing Address - Fax:330-759-4548
Practice Address - Street 1:2000 MILTON BLVD
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-9793
Practice Address - Country:US
Practice Address - Phone:330-872-5737
Practice Address - Fax:330-872-7400
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15223332B00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies