NPIMap

Organization Active NPI

Charles E, Dyer III DDS

  • Dentist
  • Beaumont, TX
National Provider Identifier
1083988265
Registry record updated Mar 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10691 Issued in TX
Legal business name
CHARLES E, DYER III DDS
Practice address
1120 Longfellow Dr
Beaumont, TX 77706-4845
Phone
(409) 989-8923
Fax
(409) 892-1960
NPI assigned
Mar 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2012

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

Authorized official

Name
Dr. Charles E Dyer III, DDS MSD
Title
President
Phone
(409) 898-8923

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 10691 TX Primary

Addresses

Primary practice location

1120 Longfellow Dr
Beaumont, TX 77706-4845

Mailing address

1120 Longfellow Dr
Beaumont, TX 77706-4845
Phone (409) 989-8923

Other identifiers 1

IdentifierTypeStateIssuer
090898001MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Spartanburg Regional72 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 4

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

1120 Longfellow Dr
Beaumont, TX 77706
Phone (409) 898-7847

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1330992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330992000000",
    "number": "1083988265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 LONGFELLOW DR",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777064845",
            "telephone_number": "409-989-8923",
            "fax_number": "409-892-1960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 LONGFELLOW DR",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777064845",
            "telephone_number": "409-989-8923",
            "fax_number": "409-892-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES E, DYER III DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-06",
        "last_updated": "2012-03-06",
        "status": "A",
        "authorized_official_last_name": "DYER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "409-898-8923",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS MSD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "10691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "090898001",
            "state": "TX"
        }
    ],
    "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 Mar 6, 2012; 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.