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General NPI Number Information
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NPI Number | 1518167584
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Entity Type | Organization
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Legal Business Name | CHARLES A. BLUMLE D.D.S., P.C.
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 404 N MAPLE ST
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City | EMPORIUM
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State | PA
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Zip | 15834-1225
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Country | US
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Telephone | 814-486-0650
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Fax |
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Provider Business Mailing Address
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Address Line | 404 N MAPLE ST
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City | EMPORIUM
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State | PA
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Zip | 15834-1225
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Country | US
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Telephone | 814-486-0650
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES A. BLUMLE
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Credential | D.D.S.
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Telephone | 814-486-0650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS-019669-L
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License Number State | PA
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