MEDICARE: DR. LAILA SUZETTE CARR 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	122300000X	Dentist	18003	MI

General Provider Information

NPI Number	:	1679540421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAILA SUZETTE CARR DDS

Provider Business Mailing Address
First Line	:	256 3RD ST
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-2606
Country	:	US
Telephone Number	:	734-697-9200
Fax Number	:	734-697-9293

Provider Business Practice Location Address
First Line	:	256 3RD ST
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-2606
Country	:	US
Telephone Number	:	734-697-9200
Fax Number	:	734-697-9293

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	09/09/2015

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