Provider Demographics
NPI:1568474989
Name:THOMAS D. CHARBENEAU, DDS, MSD, PA
Entity Type:Organization
Organization Name:THOMAS D. CHARBENEAU, DDS, MSD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHARBENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-785-4832
Mailing Address - Street 1:3420 CLARKSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-8014
Mailing Address - Country:US
Mailing Address - Phone:903-785-4832
Mailing Address - Fax:903-785-3807
Practice Address - Street 1:3420 CLARKSVILLE ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-8014
Practice Address - Country:US
Practice Address - Phone:903-785-4832
Practice Address - Fax:903-785-3807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115541223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty