Provider Demographics
NPI:1386689412
Name:HALL, CHARLES TERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:TERRY
Last Name:HALL
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 1:2378 PARK PLACE DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-2214
Mailing Address - Country:US
Mailing Address - Phone:228-896-9347
Mailing Address - Fax:
Practice Address - Street 1:VA MEDICAL CENTER, DENTAL CLINIC
Practice Address - Street 2:400 VETERANS AVE
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531
Practice Address - Country:US
Practice Address - Phone:228-523-5103
Practice Address - Fax:228-523-4910
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1753771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice