MEDICARE: CHARLES E EARNHARDT DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	DN18116	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992999023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES E EARNHARDT DMD

Provider Business Mailing Address
First Line	:	926 GREAT POND DR STE 2003
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-7244
Country	:	US
Telephone Number	:	407-772-5124
Fax Number	:	407-788-3572

Provider Business Practice Location Address
First Line	:	949 N 14TH ST
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-3838
Country	:	US
Telephone Number	:	352-460-0164
Fax Number	:	352-460-0164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	01/26/2021

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