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NPI Code Detail

MEDICARE: CHARLES GREGORY STEPHEN-HASSARD D.D.S.

MEDICARE: CHARLES GREGORY STEPHEN-HASSARD D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry3673WV

General Provider Information

NPI Number : 1184619538
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES GREGORY STEPHEN-HASSARD D.D.S.
Provider Business Mailing Address
First Line : 67 RIPE BERRY LN
Second Line :
City : MARTINSBURG
State : WV
Zip : 25403-4882
Country : US
Telephone Number : 617-759-2261
Fax Number :
Provider Business Practice Location Address
First Line : 1003 SUSHRUTA DR
Second Line :
City : MARTINSBURG
State : WV
Zip : 25401-8876
Country : US
Telephone Number : 304-263-3367
Fax Number : 304-263-1634
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2005
Last Update Date : 05/28/2009

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