Provider Demographics
NPI:1457562241
Name:PAUL S DECARLO JR. D.D.S., P.A.
Entity Type:Organization
Organization Name:PAUL S DECARLO JR. D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DECARLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:239-936-5252
Mailing Address - Street 1:47 BARKLEY CIRCLE S.W.
Mailing Address - Street 2:
Mailing Address - City:FT . MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33909-7597
Mailing Address - Country:US
Mailing Address - Phone:239-936-5252
Mailing Address - Fax:239-936-0306
Practice Address - Street 1:47 BARKLEY CIRCLE S.W.
Practice Address - Street 2:
Practice Address - City:FT . MYERS
Practice Address - State:FL
Practice Address - Zip Code:33909-7597
Practice Address - Country:US
Practice Address - Phone:239-936-5252
Practice Address - Fax:239-936-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN54681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty