Individual provider Active NPI

Charles Kimball Monagan, D.D.S.

  • General Practice Dentistry
  • Columbus, OH
National Provider Identifier
1063510725
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
20167 Issued in OH
Practice address
2456 Home Acre Dr
Columbus, OH 43231-1647
Phone
(614) 818-9420
Fax
(614) 882-9153
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 20167 OH Primary

Addresses

Primary practice location

2456 Home Acre Dr
Columbus, OH 43231-1647

Mailing address

2456 Home Acre Dr
Columbus, OH 43231-1647
Phone (614) 818-9420

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161104001345 OH Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7618255035

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
20167OHMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063510725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2456 HOME ACRE DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432311647",
            "telephone_number": "614-818-9420",
            "fax_number": "614-882-9153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2456 HOME ACRE DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432311647",
            "telephone_number": "614-818-9420",
            "fax_number": "614-882-9153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONAGAN",
        "first_name": "CHARLES",
        "middle_name": "KIMBALL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "20167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.