MEDICARE: ABC ORTHODONTICS PLLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22973	TX

General Provider Information

NPI Number	:	1699065821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC ORTHODONTICS PLLC

Provider Business Mailing Address
First Line	:	2405 FM 423 STE 100
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-6666
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7005 PASTOR BAILEY DR STE 101B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2632
Country	:	US
Telephone Number	:	972-296-3349
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLIE CARMICHAEL III
Credential	:
Telephone Number	:	214-705-7272

Provider Enumeration Date	:	04/08/2011
Last Update Date	:	04/08/2011

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Directions to “ABC ORTHODONTICS PLLC ” Practice Location

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