Active NPI
Charles F Defreest, DDS, FACP
- Prosthodontics
- Jbsa Lackland, TX
National Provider Identifier
1609825850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 30324
- Practice address
- 1100 Wilford Hall Loop BLDG 4554
Jbsa Lackland, TX 78236-5638 - Phone
- (210) 292-8488
- Fax
- (210) 292-6431
- NPI assigned
- May 8, 2006
- 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 30324 | CA | Primary |
Addresses
Primary practice location
1100 Wilford Hall Loop BLDG 4554
Jbsa Lackland, TX 78236-5638
Mailing address
133 Laburnum Dr
San Antonio, TX 78209-2121
Phone (210) 865-5035
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 |
|---|---|---|---|
| 30324 | CA | MD | Certified Respiratory Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613088000000",
"number": "1609825850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "133 LABURNUM DR",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782092121",
"telephone_number": "210-865-5035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP BLDG 4554",
"city": "JBSA LACKLAND",
"state": "TX",
"postal_code": "782365638",
"telephone_number": "210-292-8488",
"fax_number": "210-292-6431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEFREEST",
"first_name": "CHARLES",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "DDS, FACP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-08",
"last_updated": "2021-02-12",
"certification_date": "2021-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "CA",
"license": "30324",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jbsa Lackland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.