Charles C. Loberg D.D.S.,S.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5000793-015 Issued in WI

Legal business name

CHARLES C. LOBERG D.D.S.,S.C.

Practice address

201 Wisconsin St
New London, WI 54961-1171

Phone

(920) 982-5181

Fax

(920) 982-1098

NPI assigned

Mar 12, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Charles Clayton Loberg, D.D.S.

Title

President

Phone

(920) 982-5181

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922130160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 WISCONSIN ST",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549611171",
            "telephone_number": "920-982-5181",
            "fax_number": "920-982-1098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 WISCONSIN ST",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549611171",
            "telephone_number": "920-982-5181",
            "fax_number": "920-982-1098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES C. LOBERG D.D.S.,S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LOBERG",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "CLAYTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-982-5181",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5000793-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Molly Anne Ciardelli, PHARMD
• Anne Marie Collins-Reed

• General Practice Dentistry in New London, WI
• Providers in New London, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.