Provider Demographics
NPI:1073707592
Name:LIONEL L CARLOS, D.M.D., INC.
Entity Type:Organization
Organization Name:LIONEL L CARLOS, D.M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-264-0606
Mailing Address - Street 1:415 MILL ST
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-1607
Mailing Address - Country:US
Mailing Address - Phone:412-264-0606
Mailing Address - Fax:
Practice Address - Street 1:415 MILL ST
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-1607
Practice Address - Country:US
Practice Address - Phone:412-264-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA028298L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty