Provider Demographics
NPI:1144244716
Name:CHARLES A HARRELL, D.D.S., P.L.
Entity Type:Organization
Organization Name:CHARLES A HARRELL, D.D.S., P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-258-7500
Mailing Address - Street 1:624 S RIDGEWOOD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4966
Mailing Address - Country:US
Mailing Address - Phone:386-258-7500
Mailing Address - Fax:386-238-5388
Practice Address - Street 1:624 S RIDGEWOOD AVE STE C
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4966
Practice Address - Country:US
Practice Address - Phone:386-258-7500
Practice Address - Fax:386-238-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty