NPIMap

Organization Active NPI

Charles K. Dematte DDS Inc

  • General Practice Dentistry
  • Bridgeport, OH
National Provider Identifier
1801050968
Registry record updated Jul 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
15334 Issued in OH
Legal business name
CHARLES K. DEMATTE DDS INC
Practice address
334 Main St
Bridgeport, OH 43912-1346
Phone
(740) 635-2567
Fax
(740) 635-1976
NPI assigned
Jul 17, 2008
Last updated
Jul 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2008

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

Authorized official

Name
Dr. Charles Kenneth Dematte Jr., DDSNPI 1578601498
Title
Owner
Phone
(740) 635-2567

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 15334 OH Primary

Addresses

Primary practice location

334 Main St
Bridgeport, OH 43912-1346

Mailing address

334 Main St
Bridgeport, OH 43912-1346
Phone (740) 635-2567

Other identifiers 1

IdentifierTypeStateIssuer
0604019MedicaidOH

National Provider Directory

National Provider Directory

Locations

334 Main St
Bridgeport, OH 43912
Phone (740) 635-2567

Practitioners & affiliated clinicians

Practitioners 2

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": "1216252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216252800000",
    "number": "1801050968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "334 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "OH",
            "postal_code": "439121346",
            "telephone_number": "740-635-2567",
            "fax_number": "740-635-1976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "334 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "OH",
            "postal_code": "439121346",
            "telephone_number": "740-635-2567",
            "fax_number": "740-635-1976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES K. DEMATTE DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-17",
        "last_updated": "2008-07-17",
        "status": "A",
        "authorized_official_last_name": "DEMATTE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "740-635-2567",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "15334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0604019",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2008; 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.