Charle A Warren, D.D.S.

Key facts

NPI

1477582948

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

D-1872 (ID)

Practice address

301 Scott Ave
Rupert, ID 83350-1800

Phone

(208) 436-6406

Fax

(208) 436-9678

NPI assigned

Jun 30, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Doctors Garrard and Wayment Dentists PLLC General Practice Dentistry · Rupert, ID · NPI 1497974141
  NPD (past) GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477582948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 338",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833500338",
            "telephone_number": "208-436-6406",
            "fax_number": "208-436-9678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 SCOTT AVE",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833501800",
            "telephone_number": "208-436-6406",
            "fax_number": "208-436-9678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "CHARLE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-1872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010012350",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "1872",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "436398",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "6F670",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rupert, ID

• Town Square Dental PLLC
• Maria L Vega
• Victoria Rose Vega, PA-C
• David Dale Wageman, DO
• David O Ward, PHARMD
• Robert P Wayment, DDS
• Hayden Wheatley, PA-C
• Ryan James Wilkinson, LMSW
• Bill Rhys Williams, O.D.
• Gerald A Woodworth, D.M.D.

All providers in Rupert, ID · General Practice Dentistry in Idaho