Provider Demographics
NPI:1700982063
Name:CABANISS, CHARLES KENT (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:KENT
Last Name:CABANISS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:710 DENBIGH BOULEVARD
Mailing Address - Street 2:BUILDING 7 SUITE D
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VI
Mailing Address - Zip Code:23608
Mailing Address - Country:US
Mailing Address - Phone:757-877-9325
Mailing Address - Fax:757-874-2466
Practice Address - Street 1:710 DENBIGH BOULEVARD
Practice Address - Street 2:BUILDING 7 SUITE D
Practice Address - City:NEWPORT NEWS
Practice Address - State:VI
Practice Address - Zip Code:23608
Practice Address - Country:US
Practice Address - Phone:757-877-9325
Practice Address - Fax:757-874-2466
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0401007048122300000X
VA04380000321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery