Charles Milton Waller, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2002029904 Issued in MO

Practice address

272 Blue Haven Beach Rd
Camdenton, MO 65020-2123

Phone

(573) 873-5111

Fax

(573) 873-5111

NPI assigned

Feb 25, 2007

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1172361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199059200000",
    "number": "1861528929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 BLUE HAVEN BEACH RD",
            "city": "CAMDENTON",
            "state": "MO",
            "postal_code": "650202123",
            "telephone_number": "573-873-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "272 BLUE HAVEN BEACH RD",
            "city": "CAMDENTON",
            "state": "MO",
            "postal_code": "650202123",
            "telephone_number": "573-873-5111",
            "fax_number": "573-873-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "CHARLES",
        "middle_name": "MILTON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-25",
        "last_updated": "2007-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2002029904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Camdenton, MO
• Providers in Camdenton, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2007; 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.