Individual provider Active NPI

Charles Glenn Widmer, D.D.S., M.S.

  • Dentist
  • Gainesville, FL
National Provider Identifier
1669439261
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN 9021 Issued in FL
Practice address
1600 SW Archer Rd
D4-4
Gainesville, FL 32610-3003
Phone
(352) 273-5800
Fax
(352) 392-3070
NPI assigned
Apr 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN 9021 FL Primary

Addresses

Primary practice location

1600 SW Archer Rd
D4-4
Gainesville, FL 32610-3003

Mailing address

PO Box 100405
Gainesville, FL 32610-0405
Phone (352) 273-5696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20160425001691 FL Practitioner - Oral Surgery 2769781822 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
DN 9021FLMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Associates Incorporated Dentist CurrentSince Feb 1, 2016 Accepting new patients
University of Florida Dentist Past Accepting new patients

Locations

1600 SW Archer Rd
#D44
Gainesville, FL 32610
Phone (352) 273-5800

1600 SW Archer Rd
Rm D26
Gainesville, FL 32610
Phone (352) 273-5380

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1669439261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100405",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100405",
            "telephone_number": "352-273-5696",
            "fax_number": "352-392-3070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "address_2": "D4-4",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326103003",
            "telephone_number": "352-273-5800",
            "fax_number": "352-392-3070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDMER",
        "first_name": "CHARLES",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN 9021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.