Provider Demographics
NPI:1205994779
Name:CROSBY, CHARLES ALBERT SR (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALBERT
Last Name:CROSBY
Suffix:SR
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 1:1624 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-7832
Mailing Address - Country:US
Mailing Address - Phone:803-329-1046
Mailing Address - Fax:803-981-7056
Practice Address - Street 1:1624 WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-7832
Practice Address - Country:US
Practice Address - Phone:803-329-1046
Practice Address - Fax:803-981-7056
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice