Provider Demographics
NPI:1881744068
Name:WUERTH, CHARLES LOUIS (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LOUIS
Last Name:WUERTH
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 1:1900 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41014-1208
Mailing Address - Country:US
Mailing Address - Phone:859-581-4770
Mailing Address - Fax:
Practice Address - Street 1:1900 MADISON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41014-1208
Practice Address - Country:US
Practice Address - Phone:859-581-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4479OtherKY BOARD OF DENTISTRY
KY60044799Medicaid
AW7835082OtherDEA NUMBER