Charles Bonner Oates, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DD1385 Issued in NM

Practice address

210 Neel Ave
Socorro, NM 87801-4649

Phone

(505) 835-1623

Fax

(505) 835-3033

NPI assigned

Mar 15, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Dr. C Bonner Oates Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1124152517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 NEEL AVE",
            "city": "SOCORRO",
            "state": "NM",
            "postal_code": "878014649",
            "telephone_number": "505-835-1623",
            "fax_number": "505-835-3033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 NEEL AVE",
            "city": "SOCORRO",
            "state": "NM",
            "postal_code": "878014649",
            "telephone_number": "505-835-1623",
            "fax_number": "505-835-3033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OATES",
        "first_name": "CHARLES",
        "middle_name": "BONNER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-15",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD1385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6465",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00084517",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "C",
            "last_name": "OATES",
            "middle_name": "BONNER",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• NM Dental Group LLC
• Mary A Norman, CFNP
• Matthew P O'Toole, OTR/L
• Angela A Ochoa, BA
• On the Cusp Dental Studio, LLC
• Jesus Jaime Paez Jr.
• Saajan Patel
• Daniel John Pelak, LPCC

• General Practice Dentistry in Socorro, NM
• Providers in Socorro, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.