Active NPI
Wilton Charles
- Dental Therapist
- Bethel, AK
National Provider Identifier
1396494373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Therapist
- License
- 25-200-DHAT
- Practice address
- 829 Chief Eddie Hoffman Hwy
Bethel, AK 99559 - Phone
- (907) 543-6100
- Fax
- (907) 543-6159
- NPI assigned
- Mar 18, 2022
- Last updated
- Jan 27, 2025
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | NU | ||
| Dental Therapist | 125J00000X | 25-200-DHAT | AK | Primary |
Addresses
Primary practice location
829 Chief Eddie Hoffman Hwy
Bethel, AK 99559
Mailing address
PO Box 528
Bethel, AK 99559-0528
Phone (907) 543-6100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1020986 | Medicaid | AK |
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 |
|---|---|---|---|
| 25-200-DHAT | AK | MD | Dental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737936000000",
"number": "1396494373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 528",
"city": "BETHEL",
"state": "AK",
"postal_code": "995590528",
"telephone_number": "907-543-6100",
"fax_number": "907-543-6159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "829 CHIEF EDDIE HOFFMAN HWY",
"city": "BETHEL",
"state": "AK",
"postal_code": "99559",
"telephone_number": "907-543-6100",
"fax_number": "907-543-6159"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHARLES",
"first_name": "WILTON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-18",
"last_updated": "2025-01-27",
"certification_date": "2025-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "125J00000X",
"taxonomy_group": "",
"desc": "Dental Therapist",
"state": "AK",
"license": "25-200-DHAT",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1020986",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethel, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.