Provider Demographics
NPI:1518167584
Name:CHARLES A. BLUMLE D.D.S., P.C.
Entity type:Organization
Organization Name:CHARLES A. BLUMLE D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLUMLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:814-486-0650
Mailing Address - Street 1:404 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIUM
Mailing Address - State:PA
Mailing Address - Zip Code:15834-1225
Mailing Address - Country:US
Mailing Address - Phone:814-486-0650
Mailing Address - Fax:
Practice Address - Street 1:404 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:EMPORIUM
Practice Address - State:PA
Practice Address - Zip Code:15834-1225
Practice Address - Country:US
Practice Address - Phone:814-486-0650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-019669-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
73459OtherBLUE CROSS/BLUE SHIELD
PA0005281700001OtherACCESS
73459OtherUNITED CONCORDIA