Healthcare Provider Details

I. General information

NPI: 1487779385
Provider Name (Legal Business Name): EMMA MARIA DICARLO DDS MDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 CYPRESS ST
SULPHUR LA
70663
US

IV. Provider business mailing address

420 CYPRESS ST
SULPHUR LA
70663
US

V. Phone/Fax

Practice location:
  • Phone: 337-528-2215
  • Fax: 337-527-7395
Mailing address:
  • Phone: 337-528-2215
  • Fax: 337-527-7395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3272
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: