MEDICARE: CHARLES A DEIGERT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	NC7574	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841478245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES A DEIGERT DDS

Provider Business Mailing Address
First Line	:	2881 RICHLANDS HWY # HYW
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-3672
Country	:	US
Telephone Number	:	252-346-6696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2881 RICHLANDS HWY # HYW
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-3672
Country	:	US
Telephone Number	:	910-346-6696
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES AARON DEIGERT
Credential	:	DDS
Telephone Number	:	910-346-6696

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	02/07/2008

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