=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649320862
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARROLL WILLIS EHRHART DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27 W HIGH ST
-----------------------------------------------------
City | WINDSOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-244-7734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 160 27 W HIGH ST
-----------------------------------------------------
City | WINDSOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-244-7734
-----------------------------------------------------
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 | DS018509L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------