Provider Demographics
NPI:1902991763
Name:JACQUELINE CARNEY DDS PC
Entity Type:Organization
Organization Name:JACQUELINE CARNEY DDS PC
Other - Org Name:CHILDRENS DENTISTRY OF CHARLOTTESVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:434-817-1817
Mailing Address - Street 1:1470 PANTOPS MOUNTAIN PLACE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911
Mailing Address - Country:US
Mailing Address - Phone:434-817-1817
Mailing Address - Fax:434-817-1819
Practice Address - Street 1:1470 PANTOPS MOUNTAIN PLACE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911
Practice Address - Country:US
Practice Address - Phone:434-817-1817
Practice Address - Fax:434-817-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410463122300000X
1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty