Healthcare Provider Details

I. General information

NPI: 1790836377
Provider Name (Legal Business Name): CHARLES L RINGGOLD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR HOSPITAL DENTISTRY INSTITUTE
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR HOSPITAL DENTISTRY INSTITUTE
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-3717
  • Fax: 319-353-6923
Mailing address:
  • Phone: 319-356-3717
  • Fax: 319-353-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number08587
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: