Provider Demographics
NPI:1467822072
Name:CARLUCCI, ERICK (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ERICK
Middle Name:
Last Name:CARLUCCI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16240 E BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-2219
Mailing Address - Country:US
Mailing Address - Phone:760-900-7586
Mailing Address - Fax:
Practice Address - Street 1:675 S WATSON RD STE 106
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3448
Practice Address - Country:US
Practice Address - Phone:760-900-7586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0093481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics