Healthcare Provider Details

I. General information

NPI: 1104935782
Provider Name (Legal Business Name): CHARLES ED KNIGHT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 LILE DR STE 240
LITTLE ROCK AR
72205-6342
US

IV. Provider business mailing address

9601 LILE DR STE 240
LITTLE ROCK AR
72205-6342
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-3008
  • Fax: 501-224-3009
Mailing address:
  • Phone: 501-224-3008
  • Fax: 501-224-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2163
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: