Organization
CHARLES A. BLUMLE D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES A. BLUMLE D.D.S. (PRESIDENT)
(814) 486-0650
Entity
Organization
Contact information
Practice address
404 N MAPLE ST, EMPORIUM, PA 15834-1225
(814) 486-0650
Mailing address
404 N MAPLE ST, EMPORIUM, PA 15834-1225
(814) 486-0650
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS-019669-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005281700001
ACCESS
PA
01
—
73459
BLUE CROSS/BLUE SHIELD
—
Enumeration date
07/18/2007
Last updated
07/18/2007
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