Provider Demographics
NPI:1609897040
Name:MEUNIER, CHARLES KEVIN (DMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:KEVIN
Last Name:MEUNIER
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 1:3564 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-8984
Mailing Address - Country:US
Mailing Address - Phone:502-955-1606
Mailing Address - Fax:502-955-1439
Practice Address - Street 1:3564 WILLOW WAY
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8984
Practice Address - Country:US
Practice Address - Phone:502-955-1606
Practice Address - Fax:502-955-1439
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6692122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60066925Medicaid