Charles W Anders, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4143 Issued in TN

Practice address

1244 5TH St
Suite 4
Jellico, TN 37762-2630

Phone

(423) 784-3587

Fax

(423) 784-7730

NPI assigned

Dec 8, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548245954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1244 5TH ST",
            "address_2": "SUITE 4",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377622630",
            "telephone_number": "423-784-3587",
            "fax_number": "423-784-7730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1244 5TH ST",
            "address_2": "SUITE 4",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377622630",
            "telephone_number": "423-784-3587",
            "fax_number": "423-784-7730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERS",
        "first_name": "CHARLES",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "4143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60055258",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• John Walter Baird, R.PH.

• General Practice Dentistry in Jellico, TN
• Providers in Jellico, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.