Active NPI
Charles T. McCarroll, D.D.S.
- Dentist
- Saint John, IN
National Provider Identifier
1174617237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- BM2319932
- Practice address
- 10033 Wicker Ave Ste 9
Saint John, IN 46373-8777 - Phone
- (219) 365-9750
- Fax
- (219) 365-9845
- NPI assigned
- Oct 3, 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 |
|---|---|---|---|---|
| Dentist | 122300000X | BM2319932 | IN | Primary |
Addresses
Primary practice location
10033 Wicker Ave Ste 9
Saint John, IN 46373-8777
Mailing address
10033 Wicker Ave Ste 9
Saint John, IN 46373-8777
Phone (219) 365-9750
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 |
|---|---|---|---|
| BM2319932 | IN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| BDD of Indiana P.C. | Dentist | 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": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174617237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10033 WICKER AVE STE 9",
"city": "SAINT JOHN",
"state": "IN",
"postal_code": "463738777",
"telephone_number": "219-365-9750",
"fax_number": "219-365-9845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10033 WICKER AVE STE 9",
"city": "SAINT JOHN",
"state": "IN",
"postal_code": "463738777",
"telephone_number": "219-365-9750",
"fax_number": "219-365-9845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCARROLL",
"first_name": "CHARLES",
"middle_name": "T.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "BM2319932",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint John, IN
- Nikhil Malik, P.T., C.E.A.S.
- Philip James Mangiaracina, DMD
- Ruba Mansour
- Dorothy Maria Mason, SLP
- Norbert A Matulis, DDS
- Brooke McDermott, MD
- Allison M McLeish, DPT
- Medical Specialists Inc., PC (Medical Specialists & Child Life Center)
- Metropolitan Eyecare Center of St. John
- Midwest Anesthesia and Pain Specialists, SC
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.