Provider Demographics
NPI:1194805762
Name:CARMODY, WILLIAM J (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:CARMODY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4893 ROCHESTER RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4971
Mailing Address - Country:US
Mailing Address - Phone:248-528-0700
Mailing Address - Fax:248-528-0607
Practice Address - Street 1:4893 ROCHESTER RD
Practice Address - Street 2:SUITE C
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-4971
Practice Address - Country:US
Practice Address - Phone:248-528-0700
Practice Address - Fax:248-528-0607
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID0129541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice