Mr Charles Kenneth Dematte Jr, DDS is a medicare enrolled "Dentist - General Practice" provider in Bridgeport, Ohio. His current practice location is
334 Main Street, Bridgeport, Ohio. You can reach out to his office (for appointments etc.) via phone at
(740) 635-2567.
Mr Charles Kenneth Dematte Jr is licensed to practice in Ohio (license number 15334) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1578601498.
Healthcare Provider's Profile
Full Name | Mr Charles Kenneth Dematte Jr |
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Gender | Male |
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Speciality | Dentist - General Practice |
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Location | 334 Main Street, Bridgeport, Ohio |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1578601498
- Provider Enumeration Date: 02/02/2007
- Last Update Date: 07/08/2007
Medicare PECOS Information:
- PECOS PAC ID: 9335577808
- Enrollment ID: I20200316001408
Medical Identifiers
Medical identifiers for Mr Charles Kenneth Dematte Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1578601498 | NPI | - | NPPES |
0604019 | Medicaid | OH | |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
1223G0001X | Dentist - General Practice | 15334 (Ohio) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Charles Kenneth Dematte Jr is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mr Charles Kenneth Dematte Jr, DDS 334 Main Street, Bridgeport, OH 43912 Ph: (740) 635-2567 | Mr Charles Kenneth Dematte Jr, DDS 334 Main Street, Bridgeport, OH 43912 Ph: (740) 635-2567 |
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