Provider Demographics
NPI:1023279882
Name:CHUNG, CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:CHUNG
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 1:2860 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8339
Mailing Address - Country:US
Mailing Address - Phone:404-545-4633
Mailing Address - Fax:
Practice Address - Street 1:2860 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8339
Practice Address - Country:US
Practice Address - Phone:770-998-5290
Practice Address - Fax:770-552-4795
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013756122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist