DR. CHARLES F DEFREEST (NPI# 1609825850) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609825850 |
| Entity Type | Individual |
| Full Name | DR. CHARLES F DEFREEST |
| Credential | DDS, FACP |
| Practice Address |
1100 Wilford Hall Loop Bldg 4554 Jbsa Lackland TX 78236-5638 |
| Mailing Address |
2133 Pepperrell St A2053 Lackland A F B TX 78236-5313 |
| Practice Telephone | 2102928488 |
| Mailing Telephone | 2102926959 |
| Mailing Fax Number | 2102922618 |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2020-09-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
30324 | CA | Dental Providers |
| Street Address |
1100 WILFORD HALL LOOP BLDG 4554 |
| City | JBSA LACKLAND |
| State | TX |
| Zip Code | 78236-5638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639176266 | Peter S Scholler | Nurse Practitioner | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 | 2005-06-28 |
| 1376144428 | Steven Hilton | Physician Assistant | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-11-05 |
| 1235759077 | Courtney Kelly | Dentist | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-04-22 |
| 1326667783 | Shreena Reddy | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-04-15 |
| 1114556685 | Magin Day | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-04-06 |
| 1346879038 | Caitlin Gonsolin | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-04-03 |
| 1497383756 | Jerry Andrew Peer | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-03-31 |
| 1083241103 | Brian Patrick Staak | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-03-26 |
| 1902438583 | Andrew Kim | Physical Therapist | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-02-11 |
| 1326694845 | Ross Stanley | Dentist | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2019-08-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063047363 | Arnoldo Arturo Gonzalez Jr. | Specialist/Technologist | 1033 Truemper St, Lackland Afb, TX 78236 | 2020-03-06 |
| 1023643343 | Meredith Grace Cockerell | Specialist/Technologist | W Military Drive, San Antonio, TX 78236 | 2020-03-06 |
| 1578120598 | Hali Rashelle Hall | Dentist | 1615 Truemper St, Blg 6418, Attn: 59ds/sgdn, Jbsa Lackland, TX 78236 | 2019-05-24 |
| 1952967077 | Paul Fianza Boseman | Nurse Practitioner | 1106 Wilford Hall Loop, San Antonio, TX 78236 | 2019-05-14 |
| 1689161978 | Kelly Jones Buckshire | Dentist | Dunn Dental Clinic, 1615 Truemper Rd, San Antonio, TX 78236 | 2018-04-23 |
| 1902308570 | Roger Louis Farney | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg. 4554, Jbsa Lackland Afb, TX 78236 | 2018-02-28 |
| 1568916856 | Thomas Maxwell Woolf | Dentist | 1100 Wilford Hall Ambulatory Surgical Center, Lackland Afb, TX 78236 | 2016-08-04 |
| 1831544956 | Michael Veronneau | Student in an Organized Health Care Education/Training Program | 59 Mdw/ge 1100 Wilford Hall Loop, Bldg. 4554, Jbsa Lackland, TX 78236 | 2016-04-26 |
| 1376906958 | David Kephart Jr. | General Practice | 1100 Wilford Hall Loop Bldg 4454, Jbsa Lackland, TX 78236 | 2016-04-01 |
| 1184084089 | Olivia Arballo | Dermatology | Wilford Hall Asc, Attn: Dept of Dermatology, 1100 Wilford Hall Loop Bldg 4554, Jbsa-lackland, TX 78236 | 2016-03-04 |
| Find all providers in zip 78236 | ||||
| Taxonomy Code | 1223P0700X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Prosthodontics |
| That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386052538 | Jenny Phung Stevens | Dentist | 1100 Wilford Hall Loop, Bldg 4554, 59 Mdw/sghc, Jbsa Lackland, TX 78236-9908 | 2014-07-31 |
| 1447462015 | Cade Adam Salmon | Dentist | 1100 Wilford Hall Loop, Bldg 4554, Attn: 59 Mdw/sghc, Jbsa Lackland, TX 78236-9908 | 2007-05-04 |
| 1467431874 | Kristen Benae Nichols | Dentist | 1100 Wilford Hall Loop, Bldg 4554, Attn: 59 Mdw/sghc, Jbsa Lackland, TX 78236 | 2006-01-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386779 | Daniela Rubiano Mejia | Dentist | 505 W Louis Henna Blvd Ste 505, Austin, TX 78728-1701 | 2020-11-05 |
| 1235738527 | Lorena Malpica | Dentist | 5602 Presidio Pkwy Apt 1411, San Antonio, TX 78249-3093 | 2020-10-19 |
| 1922606870 | Luciano Retana | Dentist | 1235 Kinwest Pkwy, Irving, TX 75063-3403 | 2020-10-13 |
| 1295332393 | Jonathan P Hawley | Dentist | 2423 Barrow St, Abilene, TX 79605-6203 | 2020-10-02 |
| 1629684402 | Ramon Noel Hernandez | Dentist | 13000 N Interstate 35 Ste 206, Austin, TX 78753-1030 | 2020-09-17 |
| 1720697600 | Silvia Sobrecueva | Dentist | 4724 Sweetwater Blvd Ste 103, Sugar Land, TX 77479-3150 | 2020-07-27 |
| 1922620400 | Luis Herra | Dentist | 3838 N Braeswood Blvd Apt 249, Houston, TX 77025-3018 | 2020-05-07 |
| 1396381398 | Sixth Dental Partner Pllc | Dentist | 6700 Stonebrook Pkwy Ste 101, Frisco, TX 75034-9639 | 2019-11-25 |
| 1902442155 | Amin Ehsan | Dentist | 106 W Gray St, Houston, Houston, TX 77019 | 2019-11-22 |
| 1629627716 | Mohammad Mehdi Imani Emadi | Dentist | 11970 N Central Expy # 430, Dallas, TX 75243 | 2019-09-10 |
| Find all providers with the same taxonomy | ||||
| City | JBSA LACKLAND |
| Zip Code | 78236 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.