Provider Demographics
NPI:1285173807
Name:PETER MICHAEL CARLIN
Entity type:Organization
Organization Name:PETER MICHAEL CARLIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-949-0611
Mailing Address - Street 1:31290 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1850
Mailing Address - Country:US
Mailing Address - Phone:586-949-0611
Mailing Address - Fax:586-949-1714
Practice Address - Street 1:31290 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1850
Practice Address - Country:US
Practice Address - Phone:586-949-0611
Practice Address - Fax:586-949-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010147871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty