Provider Demographics
NPI:1912993528
Name:RANCK, MILES E III (DMD)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:E
Last Name:RANCK
Suffix:III
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 1:720 ROWENA DR
Mailing Address - Street 2:STE 400
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-2038
Mailing Address - Country:US
Mailing Address - Phone:814-472-2300
Mailing Address - Fax:814-472-6311
Practice Address - Street 1:720 ROWENA DR
Practice Address - Street 2:STE 400
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-2038
Practice Address - Country:US
Practice Address - Phone:814-472-2300
Practice Address - Fax:814-472-6311
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016254L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042218OtherUNITED CONCORDIA
PA239261OtherGATEWAY
PA0005230940003Medicaid
PA87378OtherMED PLUS
PA0004596OtherDORAL