MEDICARE: DR. MICHAEL JEFFREY CARL DDS

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	30-018055	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437295631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JEFFREY CARL DDS

Provider Business Mailing Address
First Line	:	6204 RIDGE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45213-1316
Country	:	US
Telephone Number	:	513-731-1106
Fax Number	:

Provider Business Practice Location Address
First Line	:	6204 RIDGE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45213-1316
Country	:	US
Telephone Number	:	513-731-1106
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/09/2007

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