Active NPI
Charles C. Clausen, D.D.S.
- General Practice Dentistry
- Avondale, AZ
National Provider Identifier
1164596250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3245
- Practice address
- 13055 W McDowell Rd
Suite G103
Avondale, AZ 85323-6449 - Phone
- (623) 848-0100
- Fax
- (623) 848-3516
- NPI assigned
- Nov 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3245 | AZ | Primary |
Addresses
Primary practice location
13055 W McDowell Rd
Suite G103
Avondale, AZ 85323-6449
Mailing address
13055 W McDowell Rd
Suite G103
Avondale, AZ 85323-6449
Phone (623) 848-0100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 609902 | Other | UNITED CONCORDIA PROVIDER | |
| 3245 | Other | AZ | STATE LICENSE |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3245 | AZ | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charles Clausen DDS PC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164596250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13055 W MCDOWELL RD",
"address_2": "SUITE G103",
"city": "AVONDALE",
"state": "AZ",
"postal_code": "853236449",
"telephone_number": "623-848-0100",
"fax_number": "623-848-3516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13055 W MCDOWELL RD",
"address_2": "SUITE G103",
"city": "AVONDALE",
"state": "AZ",
"postal_code": "853236449",
"telephone_number": "623-848-0100",
"fax_number": "623-848-3516"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLAUSEN",
"first_name": "CHARLES",
"middle_name": "C.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "3245",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA PROVIDER",
"identifier": "609902",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "3245",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Avondale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.