Provider Demographics
NPI:1356461875
Name:CARMAN, MICHELLE BERNARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:BERNARD
Last Name:CARMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:CONSTANCE
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:611 DORSEY WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223
Mailing Address - Country:US
Mailing Address - Phone:502-724-1683
Mailing Address - Fax:
Practice Address - Street 1:2010 S HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4207
Practice Address - Country:US
Practice Address - Phone:502-491-0054
Practice Address - Fax:502-491-9618
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011045A1223G0001X
KY83981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100047110Medicaid
KY1356461875OtherNPI