Healthcare Provider Details

I. General information

NPI: 1831297787
Provider Name (Legal Business Name): CHARLES HALTERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 MAIN ST
HALF MOON BAY CA
94019-2187
US

IV. Provider business mailing address

185 REEF POINT RD
MOSS BEACH CA
94038-9779
US

V. Phone/Fax

Practice location:
  • Phone: 650-726-6884
  • Fax:
Mailing address:
  • Phone: 650-728-3877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number21579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: