Charles Tatlock

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DD 1861 Issued in NM

Practice address

1801 Camino de Salud NE
Suite 1200
Albuquerque, NM 87102-4516

Phone

(505) 925-4031

Fax

(505) 246-6019

NPI assigned

Oct 17, 2005

Last updated

Mar 22, 2017By 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

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 Jul 29, 2019 through Jul 29, 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.

• Stephen a. Wagner DDS,PC

  • Dental Clinic/Center
  • Albuquerque, NM
  • NPI 1932332285
  NPD (past)
• Unm Medical Group Inc

  dba Center for Development & Disability

  • Developmental Disabilities Clinic/Center
  • Albuquerque, NM
  • NPI 1851614432
  NPD (past)

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490140800000",
    "number": "1760471379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 BRADBURY DR SE",
            "address_2": "SUITE 2222",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064374",
            "telephone_number": "505-272-3120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 CAMINO DE SALUD NE",
            "address_2": "SUITE 1200",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871024516",
            "telephone_number": "505-925-4031",
            "fax_number": "505-246-6019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATLOCK",
        "first_name": "CHARLES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-17",
        "last_updated": "2017-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD 1861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gevork Grikor Tatarian, MD
• Tate Speech and Language Services, Inc
• Harrellette Tate
• Jocelyn Tate, LMT #3225
• Kezia Elizabeth Tatham, CNM
• Diann Vasquez Tator, SLP
• Philip Jerome Tatoris, LISW
• Kayleen McKenzie Tatum
• Tucker Mateakifonua Taufoou, PHARMD
• Valerie S Tausch, MD

• General Practice Dentistry in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; 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.