Provider Demographics
NPI:1790987774
Name:BIGGERSTAFF, CHARLES RICHARDSON (DDS, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARDSON
Last Name:BIGGERSTAFF
Suffix:
Gender:M
Credentials:DDS, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4233 PINE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2271
Mailing Address - Country:US
Mailing Address - Phone:910-350-2569
Mailing Address - Fax:
Practice Address - Street 1:1300 S DICKINSON DR
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-6430
Practice Address - Country:US
Practice Address - Phone:910-383-2615
Practice Address - Fax:910-383-2618
Is Sole Proprietor?:No
Enumeration Date:2007-06-02
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice