Provider Demographics
NPI:1770643678
Name:REDMOND, CHARLES A JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:REDMOND
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 JFK BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8264
Mailing Address - Country:US
Mailing Address - Phone:501-753-5594
Mailing Address - Fax:501-753-0720
Practice Address - Street 1:4137 JFK BLVD.
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8264
Practice Address - Country:US
Practice Address - Phone:501-753-5594
Practice Address - Fax:501-753-0720
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159088608Medicaid