Provider Demographics
NPI:1679540421
Name:CARR, LAILA SUZETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAILA
Middle Name:SUZETTE
Last Name:CARR
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 1:256 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2606
Mailing Address - Country:US
Mailing Address - Phone:734-697-9200
Mailing Address - Fax:734-697-9293
Practice Address - Street 1:256 3RD ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2606
Practice Address - Country:US
Practice Address - Phone:734-697-9200
Practice Address - Fax:734-697-9293
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist