Provider Demographics
NPI:1518418656
Name:DOUGLAS A CARMICAL DDS PA
Entity type:Organization
Organization Name:DOUGLAS A CARMICAL DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARMICAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-855-3313
Mailing Address - Street 1:1198 FOREST HILLS BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-2391
Mailing Address - Country:US
Mailing Address - Phone:479-855-3313
Mailing Address - Fax:479-855-4314
Practice Address - Street 1:1198 FOREST HILLS BLVD STE 107
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-2391
Practice Address - Country:US
Practice Address - Phone:479-855-3313
Practice Address - Fax:479-855-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty