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General NPI Number Information
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NPI Number | 1477783108
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Entity Type | Organization
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Legal Business Name | CARMICHAEL SURGICAL PA
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 1016 LIBERTY ST SUITE 6
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City | DALLAS
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State | TX
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Zip | 75204-5521
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Country | US
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Telephone | 404-276-8085
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 LIBERTY ST SUITE 6
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City | DALLAS
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State | TX
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Zip | 75204-5521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | CHARLIE F CARMICHAEL
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Credential | DDS, MS
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Telephone | 404-276-8085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22973
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License Number State | TX
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