Provider Demographics
NPI:1780955716
Name:CARMICHAEL PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:CARMICHAEL PEDIATRIC DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-889-1877
Mailing Address - Street 1:3592 S ATHERTON BLVD
Mailing Address - Street 2:STE #107
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7443
Mailing Address - Country:US
Mailing Address - Phone:480-889-1877
Mailing Address - Fax:480-889-1876
Practice Address - Street 1:3592 S ATHERTON BLVD
Practice Address - Street 2:STE #107
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7443
Practice Address - Country:US
Practice Address - Phone:480-889-1877
Practice Address - Fax:480-889-1876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD79891223P0221X
AZD77271223P0221X
AZD74601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty