MEDICARE: MR. CHARLES ERNEST MIKS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401006704	VA

General Provider Information

NPI Number	:	1225330574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES ERNEST MIKS D.D.S.

Provider Business Mailing Address
First Line	:	6404 L SEVEN CORNERS PLACE
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2034
Country	:	US
Telephone Number	:	703-534-5850
Fax Number	:

Provider Business Practice Location Address
First Line	:	6404 L SEVEN CORNERS PLACE
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2034
Country	:	US
Telephone Number	:	703-534-5850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	11/18/2010

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