Provider Demographics
NPI:1235249343
Name:KRAVITZ & MILLER DENTAL PC
Entity Type:Organization
Organization Name:KRAVITZ & MILLER DENTAL PC
Other - Org Name:KRAVITZ & MILLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-761-2453
Mailing Address - Street 1:890 POPLAR CHURCH RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011
Mailing Address - Country:US
Mailing Address - Phone:717-761-2453
Mailing Address - Fax:717-761-2350
Practice Address - Street 1:890 POPLAR CHURCH RD
Practice Address - Street 2:SUITE 404
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011
Practice Address - Country:US
Practice Address - Phone:717-761-2453
Practice Address - Fax:717-761-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037975122300000X
PADS020101L1223G0001X
PADS021048L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty