Provider Demographics
NPI:1912021247
Name:HALL, CHARLES R (DDS,MS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:HALL
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 MERIDIAN ST N
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4636
Mailing Address - Country:US
Mailing Address - Phone:256-428-7276
Mailing Address - Fax:256-428-7259
Practice Address - Street 1:1110 MERIDIAN ST N
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4636
Practice Address - Country:US
Practice Address - Phone:256-428-7276
Practice Address - Fax:256-428-7259
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL25581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517173OtherBCBS
AL009911665Medicaid