Individual provider Active NPI

Charles Michalak, DDS

  • General Practice Dentistry
  • Oregon, OH
National Provider Identifier
1548486376
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
16946 Issued in OH
Practice address
3448 Navarre Ave
Suite 102
Oregon, OH 43616-3448
Phone
(419) 693-0569
Fax
(419) 693-0165
NPI assigned
Apr 18, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 16946 OH Primary

Addresses

Primary practice location

3448 Navarre Ave
Suite 102
Oregon, OH 43616-3448

Mailing address

3448 Navarre Ave
Suite 102
Oregon, OH 43616-3448
Phone (419) 693-0569

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20150604002906 OH Order and Referring Only - DentistPractitioner - Dentist 6406177211

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16946OHMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548486376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3448 NAVARRE AVE",
            "address_2": "SUITE 102",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163448",
            "telephone_number": "419-693-0569",
            "fax_number": "419-693-0165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3448 NAVARRE AVE",
            "address_2": "SUITE 102",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163448",
            "telephone_number": "419-693-0569",
            "fax_number": "419-693-0165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHALAK",
        "first_name": "CHARLES",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "16946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oregon, OH

Sources for this page

Verify at the official NPI Registry.