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
1	1223G0001X	General Practice Dentistry	6091	FL

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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