Provider Demographics
NPI:1285799858
Name:CARMICHAEL, SCOTT STUART (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:STUART
Last Name:CARMICHAEL
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 1:607 CASSIDY ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6033
Mailing Address - Country:US
Mailing Address - Phone:760-433-5656
Mailing Address - Fax:760-433-1909
Practice Address - Street 1:607 CASSIDY ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6033
Practice Address - Country:US
Practice Address - Phone:760-433-5656
Practice Address - Fax:760-433-1909
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35479OtherSTATE BOARD