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General NPI Number Information
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NPI Number | 1811158876
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Entity Type | Individual
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Provider Name | CHARLES H. VANDERPOOL DMD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | HWY 264 AND JUNCTION 191 S
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City | GANADO
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State | AZ
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Zip | 86505
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Country | US
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Telephone | 928-755-4500
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Fax | 928-755-4815
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Provider Business Mailing Address
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Address Line | PO BOX 457
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City | GANADO
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State | AZ
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Zip | 86505-0457
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Country | US
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Telephone | 928-755-4500
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Fax | 928-755-4815
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D2521
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License Number State | AZ
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