Provider Demographics
NPI:1326587122
Name:CARY DENTAL CANBY
Entity Type:Organization
Organization Name:CARY DENTAL CANBY
Other - Org Name:MICHAEL D CARY DMD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-266-6844
Mailing Address - Street 1:351 NW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3505
Mailing Address - Country:US
Mailing Address - Phone:503-266-6844
Mailing Address - Fax:
Practice Address - Street 1:351 NW 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3505
Practice Address - Country:US
Practice Address - Phone:503-266-6844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6882261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental