Provider Demographics
NPI:1952613614
Name:MASSEY, CARL BENJAMIN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:BENJAMIN
Last Name:MASSEY
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6801 FAIRVIEW RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3399
Mailing Address - Country:US
Mailing Address - Phone:704-366-2568
Mailing Address - Fax:704-366-5670
Practice Address - Street 1:6801 FAIRVIEW RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3399
Practice Address - Country:US
Practice Address - Phone:704-366-2568
Practice Address - Fax:704-366-5670
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2016-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL8531223G0001X
SC70051223G0001X
NC98601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice