Active NPI
Charles H Middleton, DDS
- Dentist
- Fort Wayne, IN
National Provider Identifier
1093902264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12008119
- Practice address
- 4302 E State Blvd
Fort Wayne, IN 46815-6988 - Phone
- (260) 484-3136
- Fax
- (260) 484-3137
- NPI assigned
- Oct 1, 2007
- Last updated
- Mar 31, 2016
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 12008119 | IN | Primary |
Addresses
Primary practice location
4302 E State Blvd
Fort Wayne, IN 46815-6988
Mailing address
4302 E State Blvd
Fort Wayne, IN 46815-6988
Phone (260) 484-3136
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000055165 | Other | IN | UNITED CONCORDIA |
| 100079660A | Medicaid | IN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12008119 | IN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charles H Middleton DDS PC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- Fort Wayne, IN
- NPI 1215024989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459382400000",
"number": "1093902264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4302 E STATE BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468156988",
"telephone_number": "260-484-3136",
"fax_number": "260-484-3137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4302 E STATE BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468156988",
"telephone_number": "260-484-3136",
"fax_number": "260-484-3137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIDDLETON",
"first_name": "CHARLES",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-01",
"last_updated": "2016-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12008119",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "000055165",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100079660A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
- Rayana Michalak
- Haley Madison Michaud, PHARMD
- Michelle L. Frye, O.D. LLC
- Middleton Family Dentistry LLC (Charles H Middleton DDS)
- Allison Middleton, O.D.
- Charles Mathew Middleton, DDS
- Cierra Middleton
- Connie Suah Shim Middleton, D.D.S
- Midtown Dental P C (Shambaugh Dental Group)
- Midwest Addiction Psychiatric & Psychological Services LLC (Mapps)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.