Provider Demographics
NPI:1154307585
Name:EMRICH, CHARLES IRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:IRA
Last Name:EMRICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 PROSPEROUS PL
Mailing Address - Street 2:SUITE 20 A
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1853
Mailing Address - Country:US
Mailing Address - Phone:859-263-8888
Mailing Address - Fax:859-263-8889
Practice Address - Street 1:131 PROSPEROUS PL
Practice Address - Street 2:SUITE 20 A
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1853
Practice Address - Country:US
Practice Address - Phone:859-263-8888
Practice Address - Fax:859-263-8889
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60049855Medicaid