Provider Demographics
NPI:1356408777
Name:CHARLES J HACKETT JR DDS PC
Entity type:Organization
Organization Name:CHARLES J HACKETT JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JEFFERSON
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:8042-889-1111
Mailing Address - Street 1:PO BOX 35072
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-288-9111
Mailing Address - Fax:804-288-3759
Practice Address - Street 1:2928 NORTH AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-3613
Practice Address - Country:US
Practice Address - Phone:804-288-9111
Practice Address - Fax:804-288-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty