Healthcare Provider Details

I. General information

NPI: 1659652311
Provider Name (Legal Business Name): BUCKEYE PEDIATRIC PARTNERS AND ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S WATSON RD STE 106
BUCKEYE AZ
85326-3446
US

IV. Provider business mailing address

2860 MICHELLE FL 2
IRVINE CA
92606-1008
US

V. Phone/Fax

Practice location:
  • Phone: 623-386-5430
  • Fax: 623-386-5524
Mailing address:
  • Phone: 714-368-2077
  • Fax: 714-368-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LONNY D CARMICHAEL
Title or Position: OWNER DOCTOR
Credential: DDS
Phone: 623-386-5430