Provider Demographics
NPI:1235245333
Name:HARRELL, CHARLES HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HOWARD
Last Name:HARRELL
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 1:3560 DELAWARE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706
Mailing Address - Country:US
Mailing Address - Phone:409-892-2776
Mailing Address - Fax:409-892-9230
Practice Address - Street 1:3560 DELAWARE
Practice Address - Street 2:SUITE 206
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706
Practice Address - Country:US
Practice Address - Phone:409-892-2776
Practice Address - Fax:409-892-9230
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist