Provider Demographics
NPI:1972667681
Name:NALL, CHARLIE E (RDH)
Entity Type:Individual
Prefix:MS
First Name:CHARLIE
Middle Name:E
Last Name:NALL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N SANDHILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2547
Mailing Address - Country:US
Mailing Address - Phone:910-944-5600
Mailing Address - Fax:910-944-9334
Practice Address - Street 1:908 N SANDHILLS BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2547
Practice Address - Country:US
Practice Address - Phone:910-944-5600
Practice Address - Fax:910-944-9334
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4019124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist