Provider Demographics
NPI:1881614717
Name:HOUSAMAN, CHARLES DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DOUGLAS
Last Name:HOUSAMAN
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 1:81 MAIN ST
Mailing Address - Street 2:SUITE200
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2924
Mailing Address - Country:US
Mailing Address - Phone:843-689-9800
Mailing Address - Fax:843-689-9793
Practice Address - Street 1:81 MAIN ST
Practice Address - Street 2:SUITE200
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2924
Practice Address - Country:US
Practice Address - Phone:843-689-9800
Practice Address - Fax:843-689-9793
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice