Healthcare Provider Details

I. General information

NPI: 1952320848
Provider Name (Legal Business Name): CHARLES E. PARSONS I D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 ALYCIA DR
RICHMOND KY
40475-2363
US

IV. Provider business mailing address

106 ALYCIA DRIVE
RICHMOND KY
40475-2363
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-6414
  • Fax: 859-623-6415
Mailing address:
  • Phone: 859-623-6414
  • Fax: 859-623-6415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4723
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: