=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366884280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLOTTE HENNIGAR MILCH DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2013
-----------------------------------------------------
Last Update Date | 08/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8715 EL CAMINO REAL
-----------------------------------------------------
City | ATASCADERO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93422-5368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-466-6998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8715 EL CAMINO REAL
-----------------------------------------------------
City | ATASCADERO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93422-5368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-998-7777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 62898
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 056720
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------