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General NPI Number Information
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NPI Number | 1629312103
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Entity Type | Organization
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Legal Business Name | STEVEN A CARR DMD LTD
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Dates
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Enumeration Date | 11/21/2012
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 238 N HIGH ST
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City | CARLINVILLE
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State | IL
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Zip | 62626-1571
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Country | US
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Telephone | 217-854-2531
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Fax |
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Provider Business Mailing Address
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Address Line | 238 N HIGH ST PO BOX 506
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City | CARLINVILLE
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State | IL
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Zip | 62626-1571
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Country | US
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Telephone | 217-854-2531
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN A CARR
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Credential | D.M.D.
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Telephone | 217-854-2531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.15352
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License Number State | IL
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