Active NPI
Charles Wesley Magnuson, D.D.S.
- General Practice Dentistry
- South Bend, IN
National Provider Identifier
1578695086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- IN8114
- Practice address
- 1331 Chimes Blvd
South Bend, IN 46615-3549 - Phone
- (574) 232-2047
- Fax
- (574) 232-3252
- NPI assigned
- Mar 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | IN8114 | IN | Primary |
Addresses
Primary practice location
1331 Chimes Blvd
South Bend, IN 46615-3549
Mailing address
1331 Chimes Blvd
South Bend, IN 46615-3549
Phone (574) 232-2047
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 |
|---|---|---|---|
| IN8114 | IN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1578695086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1331 CHIMES BLVD",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466153549",
"telephone_number": "574-232-2047",
"fax_number": "574-232-3252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1331 CHIMES BLVD",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466153549",
"telephone_number": "574-232-2047",
"fax_number": "574-232-3252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAGNUSON",
"first_name": "CHARLES",
"middle_name": "WESLEY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "IN8114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.