Provider Demographics
NPI:1518418656
Name:DOUGLAS A CARMICAL, DDS, PA
Entity Type:Organization
Organization Name:DOUGLAS A CARMICAL, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARMICAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-855-3313
Mailing Address - Street 1:1493 FOREST HILLS BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-5068
Mailing Address - Country:US
Mailing Address - Phone:479-855-3313
Mailing Address - Fax:479-855-4314
Practice Address - Street 1:1493 FOREST HILLS BLVD
Practice Address - Street 2:STE C
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-5068
Practice Address - Country:US
Practice Address - Phone:479-855-3313
Practice Address - Fax:479-855-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2951261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental