Basic Information
| Provider Information | |||||||||
| NPI: | 1609136043 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHARLES | ||||||||
| FirstName: | SEMANTHA | ||||||||
| MiddleName: | NATASHA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2901 CITYPLACE WEST BLVD | ||||||||
| Address2: | APT #303 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752040358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3474466076 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4343 W CAMP WISDOM RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752372467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725723552 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 32742 | TX | Y | Dental Providers | Dentist | Pediatric Dentistry |
ID Information
| ID | Type | State | Issuer | Description | NA | 01 | NA | OTHER |