Charles A. Poblenz, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN 21362 Issued in FL

Practice address

3647 Hendricks Ave
Jacksonville, FL 32207-5360

Phone

(904) 396-4091

Fax

(904) 396-9091

NPI assigned

Jun 25, 2015

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

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1435190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1134501141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3647 HENDRICKS AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075360",
            "telephone_number": "904-396-4091",
            "fax_number": "904-396-9091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3647 HENDRICKS AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075360",
            "telephone_number": "904-396-4091",
            "fax_number": "904-396-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POBLENZ",
        "first_name": "CHARLES",
        "middle_name": "A.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-25",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 21362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Plummer, DPT
• Lauren Ashley Plummer, PT, DPT
• Jennifer Plut, AP
• Plymouth Home for Adults, Inc.
• Saw Francis PO, MD
• Theresa Garcia Poblete, PT
• Justin Podell, PT, DPT, MED, ATC
• Podiatrist on Call, LLC
• Podiatry Associates of Florida Inc
• Podiatry Associates of Florida Inc

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.