Active NPI
Charisse Colbert, DDS
- General Practice Dentistry
- Beaumont, TX
National Provider Identifier
1063579449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 17066
- Practice address
- 4105 Dowlen Rd
Suite a
Beaumont, TX 77706-6874 - Phone
- (409) 924-8100
- Fax
- (409) 924-8181
- NPI assigned
- Jan 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 17066 | TX | Primary |
Addresses
Primary practice location
4105 Dowlen Rd
Suite a
Beaumont, TX 77706-6874
Mailing address
4105 Dowlen Rd
Suite a
Beaumont, TX 77706-6874
Phone (409) 924-8100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17066 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Texas Dental Associates, PA | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420588800000",
"number": "1063579449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4105 DOWLEN RD",
"address_2": "SUITE A",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777066874",
"telephone_number": "409-924-8100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4105 DOWLEN RD",
"address_2": "SUITE A",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777066874",
"telephone_number": "409-924-8100",
"fax_number": "409-924-8181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLBERT",
"first_name": "CHARISSE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-03",
"last_updated": "2015-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "17066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.