Provider Demographics
NPI:1841478245
Name:CHARLES A DEIGERT DDS
Entity type:Organization
Organization Name:CHARLES A DEIGERT DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:DEIGERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-346-6696
Mailing Address - Street 1:2881 RICHLANDS HWY # HYW
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-3672
Mailing Address - Country:US
Mailing Address - Phone:252-346-6696
Mailing Address - Fax:
Practice Address - Street 1:2881 RICHLANDS HWY # HYW
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-3672
Practice Address - Country:US
Practice Address - Phone:910-346-6696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC75741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902PYMedicaid