=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346362241
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH ANNE CARRICO DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10407 GRAND RIVER RD SUITE 600
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48116-6532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-227-9015
-----------------------------------------------------
Fax | 810-227-6940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10407 GRAND RIVER RD SUITE 600
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48116-6532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-227-9015
-----------------------------------------------------
Fax | 810-227-6940
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 2901018769
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------