Healthcare Provider Details

I. General information

NPI: 1235249343
Provider Name (Legal Business Name): KRAVITZ & MILLER DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 POPLAR CHURCH RD SUITE 404
CAMP HILL PA
17011
US

IV. Provider business mailing address

890 POPLAR CHURCH RD SUITE 404
CAMP HILL PA
17011
US

V. Phone/Fax

Practice location:
  • Phone: 717-761-2453
  • Fax: 717-761-2350
Mailing address:
  • Phone: 717-761-2453
  • Fax: 717-761-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS037975
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS020101L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS021048L
License Number StatePA

VIII. Authorized Official

Name: DR. BRUCE A MILLER
Title or Position: DENTIST PARTNER
Credential: DMD
Phone: 717-761-2453