Charles Preston Poole, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9142 Issued in SC

Practice address

4101 Tully Rd Ste 201
Modesto, CA 95356-8981

Phone

(209) 577-0777

Fax

(209) 572-3845

NPI assigned

Nov 21, 2016

Last updated

Dec 27, 2018By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Rickey & Wong, D.D.S., Inc.

  • General Practice Dentistry
  • Modesto, CA
  • NPI 1235551342
  NPD (past)
• Rickey & Wong, DDS, Inc.

  • General Practice Dentistry
  • Modesto, CA
  • NPI 1154652840
  NPD (past)

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

{
    "created_epoch": "1479686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545868800000",
    "number": "1851834964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3608 DALE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953560500",
            "telephone_number": "209-577-0777",
            "fax_number": "209-577-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 TULLY RD STE 201",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953568981",
            "telephone_number": "209-577-0777",
            "fax_number": "209-572-3845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "CHARLES",
        "middle_name": "PRESTON",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-21",
        "last_updated": "2018-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "100373",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "9142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kourtni Pombo
• Erah Caras Pongos
• Aniruddha Pongurlekar
• Jon E Pont, M.D.
• Nathalia Silva de Azevedo Pontes
• Lomesh Jayantilal Popat, DDS
• Dallen Pope, DPM
• Megan Marie Pope, NP
• Ryan Poppin, D.D.S.
• Ramiro Porras

• General Practice Dentistry in Modesto, CA
• Providers in Modesto, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2018; 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.