Mallory Charging, D.D.S.
Individual provider Active NPI General Practice Dentistry · Wittenberg, WI
NPI 1215316765 · NPPES record last updated May 21, 2019
Key facts
- NPI
- 1215316765
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 1001102 (WI)
- Practice address
- 202 E Grand Ave
Wittenberg, WI 54499-7600 - Phone
- (715) 253-3200
- NPI assigned
- May 28, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160406000076 | WI | Order and Referring Only - Oral Surgery |
9931407046 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001102 | WI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Szmanda Dental Center | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1001102 | WI | Yes |
Addresses
Primary practice location
202 E Grand Ave
Wittenberg, WI 54499-7600
Mailing address
202 E Grand Ave
Wittenberg, WI 54499-7600
Phone (715) 253-3200
Other practice location 1
605 S 24th Ave
Suite 10
Wausau, WI 54401-1705
Phone (715) 845-9238
Other providers in Wittenberg, WI
- Below Chiropractic Inc
- Bruce A Beversdorf
- Sarah Bradley
- Margaret Patrice Bresnahan I
- Emily M Calonder
- Kristin Craker
- Paul Bryan Dahms
- Emily Jeanne Desilet
- Terri Graham
- Erin Grosskopf
All providers in Wittenberg, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.