Charles Knisely Fetterhoff Jr., DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS0175276 Issued in PA

Practice address

4231 Elmerton Avenue
Harrisburg, PA 17109-2394

Phone

(717) 652-5401

Fax

(717) 652-5202

NPI assigned

Mar 27, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508984501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4231 ELMERTON AVENUE",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171092394",
            "telephone_number": "717-652-5401",
            "fax_number": "717-652-5202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4231 ELMERTON AVENUE",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171092394",
            "telephone_number": "717-652-5401",
            "fax_number": "717-652-5202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETTERHOFF",
        "first_name": "CHARLES",
        "middle_name": "KNISELY",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS0175276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Rose Ferris
• Bernadette A Fetrow, CRNA
• Karen L Fetrow, LSW
• Monica Fetrow, CRNA
• Carolyn Fetterhoff, RN
• Kelly Anna Fetterhoff, CRNP
• Dana Michelle Fetterolf, DMD
• Emily Ficco
• Jeffrey Michael Fike, DDS
• Ashley Fink, LPN

• General Practice Dentistry in Harrisburg, PA
• Providers in Harrisburg, PA by specialty
• General Practice Dentistry in Pennsylvania

• 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.

Verify at the official NPI Registry.