Individual provider · NPI-1

Charmiah Amie

Dentist · Tyler, TX

NPI number1154939155
StatusActive
Last updated in NPPESAug 21, 2023

Details

NPI
1154939155
Entity type
Individual (NPI-1)
Name
Charmiah Amie
Sex
Female
Sole proprietor
No
Enumeration date
Jul 16, 2020
Certification date
Aug 21, 2023
Last updated
Aug 21, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentistdn122511GAYes
1223G0001X Dentist, General Practice36314TX

Practice location

3873 Hwy 64 W
Tyler, TX 75704-6925

Phone 903-593-4872

Mailing address

2057 Yasmeen Cir
Flint, TX 75762-6733

Other practice locations

3052 N Eastman Rd Ste 108
Longview, TX 75605-5013

Phone 903-686-1905

8942 S Broadway Ave Ste 128
Tyler, TX 75703-5443

Phone 903-405-1552

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