Provider Demographics
NPI:1710101753
Name:ROBERT T CARMAN PC
Entity Type:Organization
Organization Name:ROBERT T CARMAN PC
Other - Org Name:CARMAN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-748-7328
Mailing Address - Street 1:101 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5225
Mailing Address - Country:US
Mailing Address - Phone:607-748-7328
Mailing Address - Fax:
Practice Address - Street 1:101 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5225
Practice Address - Country:US
Practice Address - Phone:607-748-7328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022711122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02244764Medicare ID - Type UnspecifiedFOR LICENSE NUMBER 040904
NY00689029Medicare ID - Type UnspecifiedFOR LICENSE NUMBER 022711