Provider Demographics
NPI:1730203589
Name:HULSEY, CHARLES MARTIN III (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MARTIN
Last Name:HULSEY
Suffix:III
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16787 BERNARDO CENTER DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2504
Mailing Address - Country:US
Mailing Address - Phone:858-485-5577
Mailing Address - Fax:
Practice Address - Street 1:16787 BERNARDO CENTER DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2504
Practice Address - Country:US
Practice Address - Phone:858-485-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA183461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics