Provider Demographics
NPI:1104935782
Name:KNIGHT, CHARLES ED (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ED
Last Name:KNIGHT
Suffix:
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 1:9601 LILE DR STE 240
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6342
Mailing Address - Country:US
Mailing Address - Phone:501-224-3008
Mailing Address - Fax:501-224-3009
Practice Address - Street 1:9601 LILE DR STE 240
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6342
Practice Address - Country:US
Practice Address - Phone:501-224-3008
Practice Address - Fax:501-224-3009
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56262OtherBLUE CROSS PROVIDER #
AR15086000040OtherQUAL CHOICE PROVIDER #
ART20360Medicare UPIN
AR56262OtherBLUE CROSS PROVIDER #