Provider Demographics
NPI:1841304722
Name:ROLPH, CHARLES W (DMD MS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:ROLPH
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 NICHOLASVILLE ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503
Mailing Address - Country:US
Mailing Address - Phone:859-278-2339
Mailing Address - Fax:859-278-2330
Practice Address - Street 1:1640 NICHOLASVILLE ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-278-2339
Practice Address - Fax:859-278-2330
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist