Colton Charles, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D4320 Issued in ID

Practice address

450 W State St Ste 180
Eagle, ID 83616-6974

Phone

(208) 939-0600

NPI assigned

Jul 22, 2010

Last updated

Jun 17, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• CSC Dental PC

  • Dental Clinic/Center
  • Meridian, ID
  • NPI 1447921747
  NPD Authorized official
• Dan Streeby, D.D.S.

  • Pediatric Dentistry
  • Eagle, ID
  • NPI 1861015653
  NPD
• Brian W Charles DMD

  • Dental Clinic/Center
  • McCall, ID
  • NPI 1023324621
  NPD (past)

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

{
    "created_epoch": "1279756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592352000000",
    "number": "1073826772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 W STATE ST STE 180",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166974",
            "telephone_number": "208-939-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 W STATE ST STE 180",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166974",
            "telephone_number": "208-939-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARLES",
        "first_name": "COLTON",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-22",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "D-4320",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janet Houston Casabonne, M.S.,CCC-SLP
• Cascadia Hospice of Idaho LLC (Avencare Hospice)
• Isabella Castillo
• Castlebury Dental PC
• Cep America, LLC (Vituity)
• Rebecca Charlton
• Judith Lauren Chasin, MD
• Lauren Chavis, PSYD
• George D. Chen, DDS
• Nick Christensen, NP

• General Practice Dentistry in Eagle, ID
• Providers in Eagle, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.