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General NPI Number Information
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NPI Number | 1780955716
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Entity Type | Organization
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Legal Business Name | CARMICHAEL PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 3592 S ATHERTON BLVD STE #107
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City | GILBERT
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State | AZ
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Zip | 85297-7443
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Country | US
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Telephone | 480-889-1877
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Fax | 480-889-1876
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Provider Business Mailing Address
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Address Line | 3592 S ATHERTON BLVD STE #107
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City | GILBERT
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State | AZ
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Zip | 85297-7443
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Country | US
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Telephone | 480-889-1877
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Fax | 480-889-1876
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Authorized Official
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Title or Position | OWNER/DDS
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Name | MR. LONNY CARMICHAEL
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Credential | DDS
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Telephone | 480-889-1877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D7989
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D7727
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D7460
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License Number State | AZ
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