Provider Demographics
NPI:1730120056
Name:PARRISH, CHARLES TYRONE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:TYRONE
Last Name:PARRISH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 W MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1309
Mailing Address - Country:US
Mailing Address - Phone:334-794-7063
Mailing Address - Fax:334-794-7063
Practice Address - Street 1:1389 W MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1309
Practice Address - Country:US
Practice Address - Phone:334-794-7063
Practice Address - Fax:334-794-7063
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice