Provider Demographics
NPI:1821152521
Name:MILLHEIM, GERALD KERMIT (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:KERMIT
Last Name:MILLHEIM
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 1:303 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-1521
Mailing Address - Country:US
Mailing Address - Phone:610-837-7656
Mailing Address - Fax:610-837-6989
Practice Address - Street 1:303 ALLEN ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014-1521
Practice Address - Country:US
Practice Address - Phone:610-837-7656
Practice Address - Fax:610-837-6989
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS20105L1223G0001X
KY43911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice