Provider Demographics
NPI:1891889937
Name:CARMICHAEL, CHARLIE F (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:F
Last Name:CARMICHAEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 LIBERTY ST
Mailing Address - Street 2:STE 6
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5521
Mailing Address - Country:US
Mailing Address - Phone:972-416-5755
Mailing Address - Fax:
Practice Address - Street 1:1016 LIBERTY ST
Practice Address - Street 2:STE 6
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5521
Practice Address - Country:US
Practice Address - Phone:972-416-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22973122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics