MEDICARE: CHARLES A REDMOND DDS, PA

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	261QD0000X	Dental Clinic/Center	2264	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558597310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES A REDMOND DDS, PA

Provider Business Mailing Address
First Line	:	4137 JFK BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-8264
Country	:	US
Telephone Number	:	501-753-5594
Fax Number	:	501-753-5880

Provider Business Practice Location Address
First Line	:	4137 JFK BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-8264
Country	:	US
Telephone Number	:	501-753-5594
Fax Number	:	501-753-5880

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES A REDMOND
Credential	:	DDS
Telephone Number	:	501-753-5594

Provider Enumeration Date	:	06/08/2009
Last Update Date	:	06/08/2009

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