Active NPI
Charles Reginald Cleveland Jr., DDS
- General Practice Dentistry
- Sealy, TX
National Provider Identifier
1477656916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10578
- Practice address
- 107 Main
Sealy, TX 77474 - Phone
- (979) 885-3355
- Fax
- (979) 885-0809
- NPI assigned
- Sep 7, 2006
- Last updated
- May 6, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10578 | TX | Primary |
Addresses
Primary practice location
107 Main
Sealy, TX 77474
Mailing address
107 Main
Sealy, TX 77474
Phone (979) 885-3355
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 |
|---|---|---|---|
| 10578 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430870400000",
"number": "1477656916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 MAIN",
"city": "SEALY",
"state": "TX",
"postal_code": "77474",
"telephone_number": "979-885-3355",
"fax_number": "979-885-0809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 MAIN",
"city": "SEALY",
"state": "TX",
"postal_code": "77474",
"telephone_number": "979-885-3355",
"fax_number": "979-885-0809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEVELAND",
"first_name": "CHARLES",
"middle_name": "REGINALD",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2015-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "10578",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sealy, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.