Active NPI
Charles Edwin Faulkner, D.D.S.
- Dentist
- Pace, FL
National Provider Identifier
1548421589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN 18343
- Practice address
- 4041 Highway 90
Pace, FL 32571-1917 - Phone
- (850) 994-8185
- NPI assigned
- Jun 23, 2008
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN 18343 | FL | Primary |
Addresses
Primary practice location
4041 Highway 90
Pace, FL 32571-1917
Mailing address
4041 Highway 90
Pace, FL 32571-1917
Phone (850) 994-8185
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150723008650 | FL | Order and Referring Only - Dentist | 9436462181 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN 18343 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adc Ventures PLLC | Dentist | Current | Accepting new patients |
Locations
4041 Highway 90
Pace, FL 32571
Phone (850) 994-8185
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214179200000",
"number": "1548421589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4041 HIGHWAY 90",
"city": "PACE",
"state": "FL",
"postal_code": "325711917",
"telephone_number": "850-994-8185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4041 HIGHWAY 90",
"city": "PACE",
"state": "FL",
"postal_code": "325711917",
"telephone_number": "850-994-8185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAULKNER",
"first_name": "CHARLES",
"middle_name": "EDWIN",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-23",
"last_updated": "2008-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN 18343",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pace, FL
- Katelyn Elizabeth Fahey
- Faith and Transformation Center LLC (Faith and Transformation Therapy)
- Family Care Concierge LLC
- Family Caregivers of Florida LLC
- Paz America Fannin, RN
- Forrest Faulkner, DMD
- Carolyn Hammack Fierro, M. S. CCC
- Crystal Fillingim, LMHC
- First Physicians Group PA
- Carla W. Fisher, ITDS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; 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.