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General NPI Number Information
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NPI Number | 1376712471
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Entity Type | Organization
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Legal Business Name | CHARLES SAMMONS, DDS, PLLC
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 202 WATER STREET
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City | LOUISA
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State | KY
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Zip | 41230
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Country | US
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Telephone | 606-638-3400
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Fax | 606-638-3410
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Provider Business Mailing Address
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Address Line | 202 WATER STREET
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City | LOUISA
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State | KY
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Zip | 41230
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Country | US
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Telephone | 606-638-3400
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHARLES SAMMONS
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Credential | DDS
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Telephone | 606-638-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 6092
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 6092
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License Number State | KY
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