Provider Demographics
NPI:1639364722
Name:LACARRIERE, MARIE CLAUDE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:CLAUDE
Last Name:LACARRIERE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-3001
Mailing Address - Country:US
Mailing Address - Phone:212-732-7400
Mailing Address - Fax:718-941-9657
Practice Address - Street 1:775 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1901
Practice Address - Country:US
Practice Address - Phone:718-941-9656
Practice Address - Fax:718-941-9657
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0463361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01623936Medicaid
NY752991770OtherINSURANCE