Provider Demographics
NPI:1063470870
Name:JAWORSKI, CAROL MARIE (RDH)
Entity Type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:MARIE
Last Name:JAWORSKI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:MARIE
Other - Last Name:JAWORSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:PO BOX PH
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-8000
Mailing Address - Country:US
Mailing Address - Phone:928-674-7001
Mailing Address - Fax:
Practice Address - Street 1:PO BOX PH
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503-8000
Practice Address - Country:US
Practice Address - Phone:928-674-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH01517124Q00000X, 124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C9502OtherBCBS
MI1063470870Medicaid
MIP93198OtherBCN
MI383518314OtherTAX ID