Provider Demographics
NPI:1710065438
Name:CARICO, PAUL HERMAN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HERMAN
Last Name:CARICO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 CROWN PT RD EAST
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377
Mailing Address - Country:US
Mailing Address - Phone:423-886-5135
Mailing Address - Fax:
Practice Address - Street 1:830 CHEROKEE BLVD
Practice Address - Street 2:CHATTANOOGA CENTER FOR COMPREHENSIVE DENTISTRY
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405
Practice Address - Country:US
Practice Address - Phone:423-756-1540
Practice Address - Fax:423-756-3462
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0027991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN002799OtherDELTA DENTAL
TN2009060OtherBCBS