Healthcare Provider Details

I. General information

NPI: 1902821028
Provider Name (Legal Business Name): MICHAEL D CARY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 NW 4TH AVE
CANBY OR
97013-3505
US

IV. Provider business mailing address

351 NW 4TH AVE
CANBY OR
97013-3505
US

V. Phone/Fax

Practice location:
  • Phone: 503-266-6844
  • Fax: 503-266-8464
Mailing address:
  • Phone: 503-266-6844
  • Fax: 503-266-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6882
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: