Provider Demographics
NPI:1285645473
Name:VENNERI, CHARLES R (DMD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:VENNERI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 DANIEL DR.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401
Mailing Address - Country:US
Mailing Address - Phone:724-437-0937
Mailing Address - Fax:724-437-1708
Practice Address - Street 1:110 DANIEL DR.
Practice Address - Street 2:SUITE 3
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-437-0937
Practice Address - Fax:724-437-1708
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022954L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009110770003Medicaid
PA66726OtherUNISON