Provider Demographics
NPI:1851668065
Name:MACO, CARMEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:MACO
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 1:231 COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4441
Mailing Address - Country:US
Mailing Address - Phone:954-771-1117
Mailing Address - Fax:954-771-8454
Practice Address - Street 1:231 COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-4441
Practice Address - Country:US
Practice Address - Phone:954-771-1117
Practice Address - Fax:954-771-8454
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 194661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice