Charris Allen

Individual provider Active NPI General Practice Dentistry · Newark, DE

NPI 1073192563 · NPPES record last updated Jul 26, 2022

Key facts

NPI
1073192563
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
0011521 (DE)
Practice address
300 Biddle Ave Ste 204
Newark, DE 19702-3972
Phone
(302) 838-8306
NPI assigned
Apr 3, 2021
Sex
Female
Sole proprietor
Yes

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.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20210616002325 DE Order and Referring Only - Dentist
Practitioner - Dentist
5799185419

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
0011521DEMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Smile Brite Dental Care Past
since Jul 31, 2022
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0011521 DE Yes

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

TypeEndpointUseAffiliation
CONNECT URL Newark

Other providers in Newark, DE

All providers in Newark, DE · General Practice Dentistry in Delaware

Sources for this page

Verify at the official NPI Registry.