Provider Demographics
NPI:1548288368
Name:URIBE, CARLOS
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:URIBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4418
Mailing Address - Country:US
Mailing Address - Phone:989-832-8889
Mailing Address - Fax:989-837-3699
Practice Address - Street 1:207 HAROLD ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4418
Practice Address - Country:US
Practice Address - Phone:989-832-8889
Practice Address - Fax:989-837-3699
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010189781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4651501Medicaid