Provider Demographics
NPI:1376840207
Name:MICHAEL D CERVERIS DMD PC
Entity Type:Organization
Organization Name:MICHAEL D CERVERIS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CERVERIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-263-0449
Mailing Address - Street 1:1854 WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17202-8836
Mailing Address - Country:US
Mailing Address - Phone:717-263-0449
Mailing Address - Fax:717-263-6870
Practice Address - Street 1:1854 WAYNE RD
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202-8836
Practice Address - Country:US
Practice Address - Phone:717-263-0449
Practice Address - Fax:717-263-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD5018698L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty