Provider Demographics
NPI:1346687803
Name:CHARETTE, JYME RAE (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:JYME
Middle Name:RAE
Last Name:CHARETTE
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7807 SHELBYVILLE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-9000
Mailing Address - Country:US
Mailing Address - Phone:502-483-8083
Mailing Address - Fax:
Practice Address - Street 1:7807 SHELBYVILLE RD STE 202
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-9000
Practice Address - Country:US
Practice Address - Phone:502-483-8083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY93781223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty