Provider Demographics
NPI:1477089019
Name:BENJAMIN L. CARRICO DMD INC.PC
Entity Type:Organization
Organization Name:BENJAMIN L. CARRICO DMD INC.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KUNSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-980-4021
Mailing Address - Street 1:95 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATTANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16258-1903
Mailing Address - Country:US
Mailing Address - Phone:814-980-4021
Mailing Address - Fax:814-764-6173
Practice Address - Street 1:95 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATTANVILLE
Practice Address - State:PA
Practice Address - Zip Code:16258-1903
Practice Address - Country:US
Practice Address - Phone:814-980-4021
Practice Address - Fax:814-764-6173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0365531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1720106768OtherDENTIST