Healthcare Provider Details

I. General information

NPI: 1205908977
Provider Name (Legal Business Name): VINCENT M CAREY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PROFESSIONAL DRIVE
WARNER ROBINS GA
31088
US

IV. Provider business mailing address

700 PROFESSIONAL DRIVE
WARNER ROBINS GA
31088
US

V. Phone/Fax

Practice location:
  • Phone: 479-333-2336
  • Fax: 479-333-6750
Mailing address:
  • Phone: 479-333-2336
  • Fax: 479-333-6750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number011039
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN011039
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: