Healthcare Provider Details

I. General information

NPI: 1558597310
Provider Name (Legal Business Name): CHARLES A REDMOND DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4137 JFK BLVD
NORTH LITTLE ROCK AR
72116-8264
US

IV. Provider business mailing address

4137 JFK BLVD
NORTH LITTLE ROCK AR
72116-8264
US

V. Phone/Fax

Practice location:
  • Phone: 501-753-5594
  • Fax: 501-753-5880
Mailing address:
  • Phone: 501-753-5594
  • Fax: 501-753-5880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2264
License Number StateAR

VIII. Authorized Official

Name: DR. CHARLES A REDMOND
Title or Position: PRESIDENT
Credential: DDS
Phone: 501-753-5594