Provider Demographics
NPI:1619258837
Name:THOMAS V CARNAGGIO DMD MS PA,
Entity Type:Organization
Organization Name:THOMAS V CARNAGGIO DMD MS PA,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:CARNAGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:828-294-1448
Mailing Address - Street 1:3055 S NC 127 HWY
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8284
Mailing Address - Country:US
Mailing Address - Phone:828-294-1448
Mailing Address - Fax:828-294-1874
Practice Address - Street 1:3055 S NC 127 HWY
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8284
Practice Address - Country:US
Practice Address - Phone:828-294-1448
Practice Address - Fax:828-294-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910817Medicaid