Healthcare Provider Details

I. General information

NPI: 1912993528
Provider Name (Legal Business Name): MILES E RANCK III DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ROWENA DR STE 400
EBENSBURG PA
15931-2038
US

IV. Provider business mailing address

720 ROWENA DR STE 400
EBENSBURG PA
15931-2038
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-2300
  • Fax: 814-472-6311
Mailing address:
  • Phone: 814-472-2300
  • Fax: 814-472-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS016254L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: