Provider Demographics
NPI:1093802209
Name:CHARLES A. HANBY DDS PC
Entity Type:Organization
Organization Name:CHARLES A. HANBY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:HANBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-751-8631
Mailing Address - Street 1:2707 W HUNTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-7723
Mailing Address - Country:US
Mailing Address - Phone:479-756-8631
Mailing Address - Fax:479-751-7892
Practice Address - Street 1:2707 W HUNTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-7723
Practice Address - Country:US
Practice Address - Phone:479-756-8631
Practice Address - Fax:479-751-7892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
58250OtherBCBS
1303179OtherUNITED CONCORDIA
2082OtherDELTA DENTAL