Provider Demographics
NPI:1679623029
Name:BABST, CHARLES R (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:BABST
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 1:3617 W ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4046
Mailing Address - Country:US
Mailing Address - Phone:218-722-8377
Mailing Address - Fax:218-722-3117
Practice Address - Street 1:3617 W ARROWHEAD RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4046
Practice Address - Country:US
Practice Address - Phone:218-722-8377
Practice Address - Fax:218-722-3117
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN82771223S0112X
WI25351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN786318700Medicaid
MN1D109BAOtherMINNESOTA BCBS
WI33415500OtherWISCONSIN MEDICAID
MN1D109BAOtherMINNESOTA BCBS
WI33415500OtherWISCONSIN MEDICAID
WI0001Medicare PIN
MN786318700Medicaid