Provider Demographics
NPI:1871029223
Name:MICHAEL J. CARL, D.D.S., P.C.
Entity Type:Organization
Organization Name:MICHAEL J. CARL, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CARL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-496-8484
Mailing Address - Street 1:26288 M 60
Mailing Address - Street 2:P.O. BOX 527
Mailing Address - City:MENDON
Mailing Address - State:MI
Mailing Address - Zip Code:49072-9702
Mailing Address - Country:US
Mailing Address - Phone:269-496-8484
Mailing Address - Fax:269-496-8485
Practice Address - Street 1:26288 M 60
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MI
Practice Address - Zip Code:49072-9702
Practice Address - Country:US
Practice Address - Phone:269-496-8484
Practice Address - Fax:269-496-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13593OtherSTATE OF MICHIGAN LICENSE