Provider Demographics
NPI:1851075493
Name:DI CARLO, MICHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:DI CARLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 FALL OAKS CT
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-5181
Mailing Address - Country:US
Mailing Address - Phone:628-233-0486
Mailing Address - Fax:
Practice Address - Street 1:1436 MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4004
Practice Address - Country:US
Practice Address - Phone:150-372-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD118051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice