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NPI Code Detail

MEDICARE: DR. PENNY MERICLE D.M.D, M.S.D.

MEDICARE: DR. PENNY MERICLE D.M.D, M.S.D.
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
11223X0400XOrthodontics and Dentofacial Orthopedics DentistryDS025005LPA

General Provider Information

NPI Number : 1629071618
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PENNY MERICLE D.M.D, M.S.D.
Provider Business Mailing Address
First Line : 190 WELLES ST
Second Line :
City : FORTY FORT
State : PA
Zip : 18704-4968
Country : US
Telephone Number : 570-287-8700
Fax Number :
Provider Business Practice Location Address
First Line : 190 WELLES ST
Second Line :
City : FORTY FORT
State : PA
Zip : 18704-4968
Country : US
Telephone Number : 570-287-8700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 07/08/2007

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