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General NPI Number Information
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NPI Number | 1801400684
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Entity Type | Individual
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Provider Name | MICHAEL CARREON DMD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 1332 SW HIGHLAND AVE
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City | REDMOND
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State | OR
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Zip | 97756-2640
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Country | US
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Telephone | 541-504-3322
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 NW KINGWOOD AVE
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City | REDMOND
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State | OR
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Zip | 97756-7752
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Country | US
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Telephone | 541-419-4194
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D11319
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License Number State | OR
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