Charles B Miller, DMD
Individual provider Active NPI Dentist · Mercer, PA
NPI 1215041389 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215041389
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DS020421 L (PA)
- Practice address
- 200 S Erie St
Mercer, PA 16137 - Phone
- (724) 622-3833
- Fax
- (724) 662-1308
- NPI assigned
- Aug 18, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS020421 L | PA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS020421 L | PA | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005194020001 | Medicaid | PA | |
| 039953 | Other | PA | UNITED CONCORDIA |
Other providers in Mercer, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.