NPIMap

Organization Active NPI

Charles D McNutt DDS PA

  • Dentist
  • Sunrise, FL
National Provider Identifier
1174783369
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5807 Issued in FL
Legal business name
CHARLES D MCNUTT DDS PA
Practice address
3501 NW 84TH Ave
Sunrise, FL 33351-6607
Phone
(954) 741-2323
Fax
(954) 749-3606
NPI assigned
Jun 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Authorized official

Name
Dr. Charles Daniel McNutt, DDS
Title
President
Phone
(954) 741-2323

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 5807 FL Primary

Addresses

Primary practice location

3501 NW 84TH Ave
Sunrise, FL 33351-6607

Mailing address

3501 NW 84TH Ave
Sunrise, FL 33351-6607
Phone (954) 741-2323

Other identifiers 1

IdentifierTypeStateIssuer
074253800MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Charles D McNutt DDS PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1174783369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 NW 84TH AVE",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333516607",
            "telephone_number": "954-741-2323",
            "fax_number": "954-749-3606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 NW 84TH AVE",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333516607",
            "telephone_number": "954-741-2323",
            "fax_number": "954-749-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES D MCNUTT DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-11",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "MCNUTT",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-741-2323",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "5807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "074253800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunrise, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.