Healthcare Provider Details

I. General information

NPI: 1588399620
Provider Name (Legal Business Name): CHARLES HAMBLETON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S OAK KNOLL AVE
PASADENA CA
91101-7900
US

IV. Provider business mailing address

200 S OAK KNOLL AVE
PASADENA CA
91101-7900
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-0634
  • Fax:
Mailing address:
  • Phone: 626-260-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS107465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: