Provider Demographics
NPI:1265875967
Name:DAWES, CHARLES ROBERT (CMT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ROBERT
Last Name:DAWES
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 1/2 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-8001
Mailing Address - Country:US
Mailing Address - Phone:415-879-1240
Mailing Address - Fax:
Practice Address - Street 1:1 LARKSPUR PLAZA DR
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1471
Practice Address - Country:US
Practice Address - Phone:415-924-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist