NPIMap

Individual provider Active NPI

Charles William Haubrich, DDS

  • General Practice Dentistry
  • Ferndale, WA
National Provider Identifier
1992877609
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7952 Issued in WA
Practice address
6004-A Portal Way
Ferndale, WA 98248
Phone
(360) 384-3440
Fax
(360) 384-6028
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 7952 WA Primary

Addresses

Primary practice location

6004-A Portal Way
Ferndale, WA 98248

Mailing address

6004-A Portal Way
Ferndale, WA 98248
Phone (360) 384-3440

Other identifiers 3

IdentifierTypeStateIssuer
7952OtherWASTATE
57952OtherWAWDS
5029038OtherWADSHS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7952WAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Alaska Regional Health Consortium Past Accepting new patients
Michael a Sacro DDS PC Past Accepting new patients
Gustavus Community Clinic Inc Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992877609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6004-A PORTAL WAY",
            "city": "FERNDALE",
            "state": "WA",
            "postal_code": "98248",
            "telephone_number": "360-384-3440",
            "fax_number": "360-384-6028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6004-A PORTAL WAY",
            "city": "FERNDALE",
            "state": "WA",
            "postal_code": "98248",
            "telephone_number": "360-384-3440",
            "fax_number": "360-384-6028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUBRICH",
        "first_name": "CHARLES",
        "middle_name": "WILLIAM",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "7952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE",
            "identifier": "7952",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WDS",
            "identifier": "57952",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS",
            "identifier": "5029038",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ferndale, WA

Sources for this page

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

Verify at the official NPI Registry.