Provider Demographics
NPI:1568508430
Name:HALL, CHARLES VERNON (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:VERNON
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 1:7204 267TH ST NW
Mailing Address - Street 2:STE 103
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-6271
Mailing Address - Country:US
Mailing Address - Phone:360-629-5382
Mailing Address - Fax:360-629-6891
Practice Address - Street 1:7204 267TH ST NW
Practice Address - Street 2:STE 103
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6271
Practice Address - Country:US
Practice Address - Phone:360-629-5382
Practice Address - Fax:360-629-6891
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist