Provider Demographics
NPI:1487701249
Name:ASSEY, CHARLES TIMOTHY (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:TIMOTHY
Last Name:ASSEY
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 1:1041 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6156
Mailing Address - Country:US
Mailing Address - Phone:843-884-6004
Mailing Address - Fax:
Practice Address - Street 1:1041 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6156
Practice Address - Country:US
Practice Address - Phone:843-884-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist