Provider Demographics
NPI:1225150964
Name:CHARLES DUNLAP, DDS
Entity Type:Organization
Organization Name:CHARLES DUNLAP, DDS
Other - Org Name:CHARLES I. DUNLAP, D.D.S.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:IRVINE
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-858-7054
Mailing Address - Street 1:78 ALAMAR ST
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-7303
Mailing Address - Country:US
Mailing Address - Phone:706-858-7054
Mailing Address - Fax:706-858-7017
Practice Address - Street 1:78 ALAMAR ST
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-7303
Practice Address - Country:US
Practice Address - Phone:706-858-7054
Practice Address - Fax:706-858-7017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009850174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA851675668AMedicaid
TN3224795Medicare ID - Type UnspecifiedMEDICARE
GA851675668AMedicaid