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General NPI Number Information
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NPI Number | 1205194016
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Entity Type | Individual
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Provider Name | BRIAN R CARKNER DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 4 FAIRFIELD DR
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City | QUEENSBURY
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State | NY
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Zip | 12804
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Country | US
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Telephone | 187-939-4245
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Fax |
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Provider Business Mailing Address
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Address Line | 4 FAIRFIELD DR
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City | QUEENSBURY
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State | NY
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Zip | 12804-1514
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Country | US
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Telephone | 187-939-4245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 288587
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License Number State | NY
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