Provider Demographics
NPI:1952508327
Name:CARMICAL, DOUGLAS A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:CARMICAL
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 1:805 N 20TH PL
Mailing Address - Street 2:STE.2
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3495
Mailing Address - Country:US
Mailing Address - Phone:479-631-9393
Mailing Address - Fax:479-986-0905
Practice Address - Street 1:805 N 20TH PL
Practice Address - Street 2:STE.2
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3495
Practice Address - Country:US
Practice Address - Phone:479-631-9393
Practice Address - Fax:479-986-0905
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist