Healthcare Provider Details

I. General information

NPI: 1023230927
Provider Name (Legal Business Name): CARLOS ANTONIO RAMIREZ-NEYRA MD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 E 12 MILE RD STE 308
WARREN MI
48093-3491
US

IV. Provider business mailing address

1980 SOMERSET BLVD APT 102
TROY MI
48084-3935
US

V. Phone/Fax

Practice location:
  • Phone: 586-582-7100
  • Fax: 586-576-4344
Mailing address:
  • Phone: 248-890-9833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901019126
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901019126
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberME112441
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301097470
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number4301097470
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: