Individual provider Active NPI

Charris Allen

  • General Practice Dentistry
  • Newark, DE
National Provider Identifier
1073192563
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0011521 Issued in DE
Practice address
300 Biddle Ave Ste 204
Newark, DE 19702-3972
Phone
(302) 838-8306
NPI assigned
Apr 3, 2021
Last updated
Jul 26, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 26, 2022

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 0011521 DE Primary

Addresses

Primary practice location

300 Biddle Ave Ste 204
Newark, DE 19702-3972

Mailing address

501 W 14TH St
Wilmington, DE 19801-1013

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Newark

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
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
I20210616002325 DE Order and Referring Only - DentistPractitioner - Dentist 5799185419

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0011521DEMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Smile Brite Dental Care PastSince Jul 31, 2022 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1617408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658793600000",
    "number": "1073192563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 W 14TH ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198011013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 BIDDLE AVE STE 204",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197023972",
            "telephone_number": "302-838-8306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "CHARRIS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-03",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "DE",
            "license": "0011521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Newark",
            "affiliation": "N",
            "address_1": "300 Biddle Ave Ste 204",
            "city": "Newark",
            "state": "DE",
            "country_code": "US",
            "postal_code": "197023972",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.