Provider Demographics
NPI:1356579197
Name:CARLIN, FREDERICK REESE JR
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:REESE
Last Name:CARLIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96093
Mailing Address - Country:US
Mailing Address - Phone:530-623-8888
Mailing Address - Fax:530-623-8887
Practice Address - Street 1:100 HORSESHOE LANE
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093
Practice Address - Country:US
Practice Address - Phone:530-623-8888
Practice Address - Fax:530-623-8887
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252441223G0001X
UT68389321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice