NPIMap

Organization Active NPI

St. Charles Family Dental

  • General Practice Dentistry
  • Waldorf, MD
National Provider Identifier
1619359213
Registry record updated Jun 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ST. CHARLES FAMILY DENTAL
Practice address
173 Saint Patricks Dr
Suite 204
Waldorf, MD 20603-5529
Phone
(301) 645-6500
Fax
(301) 632-6492
NPI assigned
Jun 19, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2015

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

Authorized official

Name
Dr. Marilyn Coleman-Bordes, OWNER
Title
Dentist
Phone
(301) 645-6500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

173 Saint Patricks Dr
Suite 204
Waldorf, MD 20603-5529

Mailing address

173 Saint Patricks Dr
Suite 204
Waldorf, MD 20603-5529
Phone (301) 645-6500

National Provider Directory

National Provider Directory

Locations

173 Saint Patricks Dr
Ste 204
Waldorf, MD 20603
Phone (301) 645-6500

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1434672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434672000000",
    "number": "1619359213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "173 SAINT PATRICKS DR",
            "address_2": "SUITE 204",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206035529",
            "telephone_number": "301-645-6500",
            "fax_number": "301-632-6492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 SAINT PATRICKS DR",
            "address_2": "SUITE 204",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206035529",
            "telephone_number": "301-645-6500",
            "fax_number": "301-632-6492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CHARLES FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-19",
        "last_updated": "2015-06-19",
        "status": "A",
        "authorized_official_last_name": "COLEMAN-BORDES",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "301-645-6500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.