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General NPI Number Information
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NPI Number | 1356408777
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Entity Type | Organization
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Legal Business Name | CHARLES J HACKETT JR DDS PC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2928 NORTH AVE SECOND FLOOR
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City | RICHMOND
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State | VA
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Zip | 23222-3613
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Country | US
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Telephone | 804-288-9111
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Fax | 804-288-3759
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Provider Business Mailing Address
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Address Line | PO BOX 35072
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City | RICHMOND
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State | VA
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Zip | 23235
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Country | US
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Telephone | 804-288-9111
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Fax | 804-288-3759
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES JEFFERSON HACKETT JR.
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Credential | DDS
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Telephone | 80428891111
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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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