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NPI Code Detail

MEDICARE: DR. CHARLES LOUIS HADDOCK DMD

MEDICARE:  DR. CHARLES LOUIS HADDOCK  DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice Dentistry12784NC

General Provider Information

NPI Number : 1851041495
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES LOUIS HADDOCK DMD
Provider Business Mailing Address
First Line : 600 COUNTRY CLUB RD
Second Line :
City : LUMBERTON
State : NC
Zip : 28360-0428
Country : US
Telephone Number : 910-737-6457
Fax Number : 910-739-7673
Provider Business Practice Location Address
First Line : 600 COUNTRY CLUB RD
Second Line :
City : LUMBERTON
State : NC
Zip : 28360-0428
Country : US
Telephone Number : 910-737-6457
Fax Number : 910-739-7673
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2022
Last Update Date : 06/15/2022

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Directions to “ DR. CHARLES LOUIS HADDOCK DMD” Practice Location

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