Charles G Bode, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2579 Issued in AZ

Practice address

5750 W Thunderbird Rd
H-850
Glendale, AZ 85306-4660

Phone

(602) 938-0880

Fax

(602) 547-0528

NPI assigned

Sep 13, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 25, 2013 through Oct 25, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Affiliated Oral & Maxillofacial Surgeons PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Glendale, AZ
  • NPI 1013023928
  NPD (past) Authorized official
• Peter S. Nelson, DDS, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Glendale, AZ
  • NPI 1760845978
  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649375106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5750 W THUNDERBIRD RD",
            "address_2": "H-850",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064660",
            "telephone_number": "602-938-0880",
            "fax_number": "602-547-0528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5750 W THUNDERBIRD RD",
            "address_2": "H-850",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064660",
            "telephone_number": "602-938-0880",
            "fax_number": "602-547-0528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODE",
        "first_name": "CHARLES",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "2579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "AZ0116750",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "823999",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMDP",
            "identifier": "082115",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blue Bird Counseling
• Debra Michelle Blum
• Jason Boanca, PHARMD
• Mary A Bocchicchio, BS, LMT
• Alexander Bockhorst, OD
• Bodyz En Motion, LLC
• Boe (Native Empowerment)
• Shani Deon Boeh, AAS
• Robert Bofman
• Anne Bojorquez, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.