Provider Demographics
NPI:1902821028
Name:CARY, MICHAEL D (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:CARY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 NW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3505
Mailing Address - Country:US
Mailing Address - Phone:503-266-6844
Mailing Address - Fax:503-266-8464
Practice Address - Street 1:351 NW 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3505
Practice Address - Country:US
Practice Address - Phone:503-266-6844
Practice Address - Fax:503-266-8464
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD68821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice