Provider Demographics
NPI:1083197438
Name:SMAHA, CHARLES N (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:N
Last Name:SMAHA
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2821
Mailing Address - Country:US
Mailing Address - Phone:478-743-9331
Mailing Address - Fax:478-743-7195
Practice Address - Street 1:151 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2821
Practice Address - Country:US
Practice Address - Phone:478-743-9331
Practice Address - Fax:478-743-7195
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics