Charles Wohlwend Ddspc

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

CHARLES WOHLWEND DDSPC

Doing business as

Eagleridge Dental

Practice address

1044 Eagleridge Blvd
Pueblo, CO 81008-2130

Phone

(719) 542-1212

Fax

(719) 544-3854

NPI assigned

Mar 5, 2020

Last updated

Mar 5, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Charles Wohlwend, DDS

Title

Owner/Dentist

Phone

(719) 542-1212

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Eagleridge Dental Doing business as

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Charles Wohlwend Ddspc

  dba Eagleridge Dental

  • Dentist
  • Walsenburg, CO
  • NPI 1578198552
  NPPES parent name

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

{
    "created_epoch": "1583366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583366400000",
    "number": "1326673880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 EAGLERIDGE BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082130",
            "telephone_number": "719-542-1212",
            "fax_number": "719-544-3854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 EAGLERIDGE BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082130",
            "telephone_number": "719-542-1212",
            "fax_number": "719-544-3854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES WOHLWEND DDSPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-05",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A",
        "authorized_official_last_name": "WOHLWEND",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "719-542-1212",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagleridge Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amaya Lee Charboneau
• Joyce Kathy Charboneau, BS,CACII
• Charles E Schneider DPM PC
• Charles G Gordon DDS LLC
• Charles Ggordon DDS LLC
• Gregory L Charleston, AGACNP-BC
• Jody Charter
• David Chartrand, BC-HIS
• Chase Integrated Care
• Deborah Lynn Chase, FNP-C

• Dentist in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; 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.