Provider Demographics
NPI:1013284207
Name:CARMODY, ARA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARA
Middle Name:G
Last Name:CARMODY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18807 BEARDSLEE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-1712
Mailing Address - Country:US
Mailing Address - Phone:425-488-6120
Mailing Address - Fax:
Practice Address - Street 1:18807 BEARDSLEE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011
Practice Address - Country:US
Practice Address - Phone:425-488-6120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602395761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice