Active NPI
Charles Thomas Nuckols, D.M.D.
- Oral and Maxillofacial Surgery (Dentist)
- Bowling Green, KY
National Provider Identifier
1245244474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 3399
- Practice address
- 627 Eastwood Ave
Bowling Green, KY 42103-1688 - Phone
- (270) 843-4341
- Fax
- (270) 746-9551
- NPI assigned
- Jul 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 3399 | KY | Primary |
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | 3399 | KY |
Addresses
Primary practice location
627 Eastwood Ave
Bowling Green, KY 42103-1688
Mailing address
627 Eastwood Ave
Bowling Green, KY 42103-1688
Phone (270) 843-4341
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000212083 | Other | KY | ANTHEM PROVIDER ID |
| 6389 | Other | KY | DORAL DENTAL ID |
| 1115671 | Other | KY | PASSPORT GROUP PIN |
| 60033990 | Medicaid | KY | |
| 64033996 | Medicaid | KY | |
| 1069982 | Other | KY | PASSPORT HEALTH ID PIN |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789257600000",
"number": "1245244474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "627 EASTWOOD AVE",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421031688",
"telephone_number": "270-843-4341",
"fax_number": "270-746-9551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "627 EASTWOOD AVE",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421031688",
"telephone_number": "270-843-4341",
"fax_number": "270-746-9551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUCKOLS",
"first_name": "CHARLES",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2026-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "KY",
"license": "3399",
"primary": true
},
{
"code": "204E00000X",
"taxonomy_group": "",
"desc": "Oral & Maxillofacial Surgery",
"state": "KY",
"license": "3399",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER ID",
"identifier": "000000212083",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL DENTAL ID",
"identifier": "6389",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT GROUP PIN",
"identifier": "1115671",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60033990",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64033996",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT HEALTH ID PIN",
"identifier": "1069982",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bowling Green, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.