MEDICARE: DR. JAMES ANTHONY CARNELL D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00006847	WA

General Provider Information

NPI Number	:	1184905218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ANTHONY CARNELL D.D.S.

Provider Business Mailing Address
First Line	:	4610 N ASH ST STE 204
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-1482
Country	:	US
Telephone Number	:	509-326-8120
Fax Number	:	509-325-5370

Provider Business Practice Location Address
First Line	:	4610 N. ASH ST.
Second Line	:	(SUITE 204)
City	:	SPOKANE
State	:	WA
Zip	:	99205
Country	:	US
Telephone Number	:	509-326-8120
Fax Number	:	509-325-5370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	12/05/2012

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