Provider Demographics
NPI:1588855456
Name:CHARBENEAU, THOMAS D (DDS, MSD, PA)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:CHARBENEAU
Suffix:
Gender:M
Credentials:DDS, MSD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 CLARKSVILLE ST
Mailing Address - Street 2:P.O. BOX 6578
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
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115541223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1568474989OtherCORPORATION