Individual provider Active NPI

Paul James Challgren, D.D.S.

  • General Practice Dentistry
  • Lafayette, IN
National Provider Identifier
1134201056
Registry record updated Mar 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12007766 Issued in IN
Practice address
170 Professional CT
Lafayette, IN 47905-5153
Phone
(765) 446-9606
Fax
(765) 446-9699
NPI assigned
Oct 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12007766 IN Primary

Addresses

Primary practice location

170 Professional CT
Lafayette, IN 47905-5153

Mailing address

170 Professional CT
Lafayette, IN 47905-5153
Phone (765) 446-9606

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

LicenseStateTypeSpecialty
12007766INMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Challgren Dentistry PC Past Accepting new patients
Paul J. Challgren 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236988800000",
    "number": "1134201056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 PROFESSIONAL CT",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479055153",
            "telephone_number": "765-446-9606",
            "fax_number": "765-446-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 PROFESSIONAL CT",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479055153",
            "telephone_number": "765-446-9606",
            "fax_number": "765-446-9699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHALLGREN",
        "first_name": "PAUL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2009-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12007766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2009; 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.