Provider Demographics
NPI:1790014934
Name:JOHN M. CARRELS DDS
Entity Type:Organization
Organization Name:JOHN M. CARRELS DDS
Other - Org Name:CARRELS FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARRELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-225-1192
Mailing Address - Street 1:805 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-6222
Mailing Address - Country:US
Mailing Address - Phone:605-225-1192
Mailing Address - Fax:605-226-7083
Practice Address - Street 1:805 S STATE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-6222
Practice Address - Country:US
Practice Address - Phone:605-225-1192
Practice Address - Fax:605-226-7083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty