Healthcare Provider Details

I. General information

NPI: 1144226937
Provider Name (Legal Business Name): JACQUELINE M CARNEY DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2005
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 PANTOPS MOUNTAIN PL
CHARLOTTESVILLE VA
22911-4662
US

IV. Provider business mailing address

1470 PANTOPS MOUNTAIN PL
CHARLOTTESVILLE VA
22911-4662
US

V. Phone/Fax

Practice location:
  • Phone: 494-817-1817
  • Fax: 434-817-1819
Mailing address:
  • Phone: 494-817-1817
  • Fax: 434-817-1819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401410463
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number0401410463
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: