Active NPI
Charles B Miller, DMD
- Dentist
- Mercer, PA
National Provider Identifier
1215041389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS020421 L
- Practice address
- 200 S Erie St
Mercer, PA 16137 - Phone
- (724) 622-3833
- Fax
- (724) 662-1308
- NPI assigned
- Aug 18, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS020421 L | PA | Primary |
Addresses
Primary practice location
200 S Erie St
Mercer, PA 16137
Mailing address
200 S Erie St
Mercer, PA 16137
Phone (724) 622-3833
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 039953 | Other | PA | UNITED CONCORDIA |
| 0005194020001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS020421 L | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215041389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 S ERIE ST",
"city": "MERCER",
"state": "PA",
"postal_code": "16137",
"telephone_number": "724-622-3833",
"fax_number": "724-662-1308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 S ERIE ST",
"city": "MERCER",
"state": "PA",
"postal_code": "16137",
"telephone_number": "724-622-3833",
"fax_number": "724-662-1308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "CHARLES",
"middle_name": "B",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS020421 L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "039953",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0005194020001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mercer, PA
- Mercer County Behavioral Health Commission Inc
- Mercer County Behavioral Health Commission Inc
- Mercer County BHC
- Mercer Ms LLC (Medicine Shoppe)
- Mercer Pharmacy Inc (Mercer Pharmacy)
- Jonathan Moctezuma, CRNP
- Stefanie A Montgomery, LPC
- Scott David Morgan, MD
- Brijette Fenella Morris, LSW
- James Mostard-Smith
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.