Healthcare Provider Details

I. General information

NPI: 1033211107
Provider Name (Legal Business Name): CHARLES GEORGE HINTERBERGER JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EAST PLEASANT VALLEY BLVD
ALTOONA PA
16602-5544
US

IV. Provider business mailing address

125 EAST PLEASANT VALLEY BLVD
ALTOONA PA
16602-5544
US

V. Phone/Fax

Practice location:
  • Phone: 814-942-4699
  • Fax: 814-942-4699
Mailing address:
  • Phone: 814-942-4699
  • Fax: 814-942-4699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS023665L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: