Provider Demographics
NPI:1033579065
Name:CARMI FAMILY DENTAL
Entity type:Organization
Organization Name:CARMI FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-382-8300
Mailing Address - Street 1:1000 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-2402
Mailing Address - Country:US
Mailing Address - Phone:618-382-8300
Mailing Address - Fax:618-382-8322
Practice Address - Street 1:1000 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-2402
Practice Address - Country:US
Practice Address - Phone:618-382-8300
Practice Address - Fax:618-382-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty