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General NPI Number Information
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NPI Number | 1144244716
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Entity Type | Organization
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Legal Business Name | CHARLES A HARRELL, D.D.S., P.L.
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 624 S RIDGEWOOD AVE STE C
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4966
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Country | US
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Telephone | 386-258-7500
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Fax | 386-238-5388
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Provider Business Mailing Address
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Address Line | 624 S RIDGEWOOD AVE STE C
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4966
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Country | US
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Telephone | 386-258-7500
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Fax | 386-238-5388
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ANNA HARRELL
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Credential |
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Telephone | 386-258-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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