Healthcare Provider Details

I. General information

NPI: 1851483192
Provider Name (Legal Business Name): CHARLES HAMMAN HENRY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 ALBANY ST STE 446
BOSTON MA
02118-3550
US

IV. Provider business mailing address

635 ALBANY ST FL 4
BOSTON MA
02118-3550
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-4350
  • Fax: 617-358-5761
Mailing address:
  • Phone: 617-638-4350
  • Fax: 617-358-5761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN15514
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN15514
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: