Provider Demographics
NPI:1336267335
Name:CARRILLO, ANNETTE (DR)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 E VALENCIA RD
Mailing Address - Street 2:STE 130
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706
Mailing Address - Country:US
Mailing Address - Phone:520-889-2747
Mailing Address - Fax:520-573-1552
Practice Address - Street 1:2680 E VALENCIA RD
Practice Address - Street 2:STE 130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706
Practice Address - Country:US
Practice Address - Phone:520-889-2747
Practice Address - Fax:520-573-1552
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist