Provider Demographics
NPI:1417978222
Name:CARNEY, TED (DDS)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:CARNEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78957-1437
Mailing Address - Country:US
Mailing Address - Phone:512-237-4420
Mailing Address - Fax:512-237-4420
Practice Address - Street 1:300 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TX
Practice Address - Zip Code:78957-1437
Practice Address - Country:US
Practice Address - Phone:512-237-4420
Practice Address - Fax:512-237-4420
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1109274-02Medicaid