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Individual

DR. CHARLES BERYL NISSMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
137 W STREET RD, FEASTERVILLE, PA 19053-4168
(215) 322-7810
(215) 322-7832
Mailing address
137 W STREET RD, FEASTERVILLE, PA 19053-4168
(215) 322-7810
(215) 322-7832

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
DS017304L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0023182000
KEYSTONE
PA
01
160558
BLUE SHIELD
PA
01
4437
AETNA
PA
Enumeration date
02/15/2006
Last updated
07/08/2007
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