Provider Demographics
NPI:1841614989
Name:EBNER, CHARLES BRYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRYAN
Last Name:EBNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COLGATE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2624
Mailing Address - Country:US
Mailing Address - Phone:410-838-6630
Mailing Address - Fax:410-838-2616
Practice Address - Street 1:2 COLGATE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2624
Practice Address - Country:US
Practice Address - Phone:410-838-6630
Practice Address - Fax:410-838-2616
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist