Provider Demographics
NPI:1659303956
Name:BROUGHTON, CHARLES FREDERICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FREDERICK
Last Name:BROUGHTON
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 1:981 STATE ROAD 46 E
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-7631
Mailing Address - Country:US
Mailing Address - Phone:812-934-5151
Mailing Address - Fax:812-932-5151
Practice Address - Street 1:981 STATE ROAD 46 E
Practice Address - Street 2:SUITE A
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-7631
Practice Address - Country:US
Practice Address - Phone:812-934-5151
Practice Address - Fax:812-932-5151
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN74331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics