Provider Demographics
NPI:1023230927
Name:RAMIREZ-NEYRA, CARLOS ANTONIO (MD, DDS)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ANTONIO
Last Name:RAMIREZ-NEYRA
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 SOMERSET BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3935
Mailing Address - Country:US
Mailing Address - Phone:248-890-9833
Mailing Address - Fax:
Practice Address - Street 1:11900 E 12 MILE RD STE 308
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3491
Practice Address - Country:US
Practice Address - Phone:586-582-7100
Practice Address - Fax:586-576-4344
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019126122300000X, 1223S0112X
FLME112441204E00000X
MI4301097470208D00000X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice