Provider Demographics
NPI:1861411712
Name:MASSARI, CARYN CARLENE (DDS)
Entity type:Individual
Prefix:MS
First Name:CARYN
Middle Name:CARLENE
Last Name:MASSARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7429
Mailing Address - Country:US
Mailing Address - Phone:704-455-5354
Mailing Address - Fax:704-455-5334
Practice Address - Street 1:4351 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7429
Practice Address - Country:US
Practice Address - Phone:704-455-5354
Practice Address - Fax:704-455-5334
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899012JMedicaid