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NPI Code Detail

MEDICARE: DR. CHARLES ERNEST NOTTINGHAM D.D.S

MEDICARE: DR. CHARLES ERNEST NOTTINGHAM D.D.S
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
11223G0001XGeneral Practice Dentistry6091FL

General Provider Information

NPI Number : 1669568036
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES ERNEST NOTTINGHAM D.D.S
Provider Business Mailing Address
First Line : 4048 WEST HILLSBORO BLVD
Second Line :
City : DEERFIELD BEACH
State : FL
Zip : 33442
Country : US
Telephone Number : 954-429-8506
Fax Number : 954-429-9480
Provider Business Practice Location Address
First Line : 4048 WEST HILLSBORO BLVD
Second Line :
City : DEERFIELD BEACH
State : FL
Zip : 33442
Country : US
Telephone Number : 954-429-8506
Fax Number : 954-429-9480
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 07/18/2017

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