Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 0401411545 | VA |
Y | 1223P0221X | Pediatric Dentist | 7460 | AZ |
NPI | 1043352412 |
---|---|
Provider Name | Lonny D Carmichael |
First Address | Gilbert, AZ 85297-7443 |
Second Address | Gilbert, AZ 85297-7443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 07/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
348451 | (05) | AZ |