Healthcare Provider Details

I. General information

NPI: 1346687803
Provider Name (Legal Business Name): JYME RAE CHARETTE DMD, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7807 SHELBYVILLE RD STE 202
LOUISVILLE KY
40222-9000
US

IV. Provider business mailing address

7807 SHELBYVILLE RD STE 202
LOUISVILLE KY
40222-9000
US

V. Phone/Fax

Practice location:
  • Phone: 502-483-8083
  • Fax:
Mailing address:
  • Phone: 502-483-8083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number9378
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: