Charles Edward Kudwa, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901012520 Issued in MI

Practice address

510 West Lake St
Tawas City, MI 48763

Phone

(989) 362-8673

Fax

(989) 362-2771

NPI assigned

Nov 21, 2006

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

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821163106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 WEST LAKE ST",
            "address_2": "PO BOX 240",
            "city": "TAWAS CITY",
            "state": "MI",
            "postal_code": "487640240",
            "telephone_number": "989-362-8673",
            "fax_number": "989-362-2771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 WEST LAKE ST",
            "city": "TAWAS CITY",
            "state": "MI",
            "postal_code": "48763",
            "telephone_number": "989-362-8673",
            "fax_number": "989-362-2771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUDWA",
        "first_name": "CHARLES",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901012520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Lynn Kauffman, LMSW
• Michael Jay Kayner, DC
• Taylor Laine Kinney
• Bradley Arthur Kloska, D.O.
• Kalee Koronka, MA, LPC
• Nancy Elaine Laidlaw, AUD
• Lakeview Manor Acquisition Company, Inc.
• Christopher Russell Landrey, DO
• David Ballard Lane Jr., LMSW, LLP, LPC
• Melissa Loraine Lane, LLP

• Dentist in Tawas City, MI
• Providers in Tawas City, MI by specialty
• Dentist in Michigan

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.