Provider Demographics
NPI:1285848697
Name:CARMONY, NEIL WALTER (DDS)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:WALTER
Last Name:CARMONY
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 1:4115 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1511
Mailing Address - Country:US
Mailing Address - Phone:870-772-4106
Mailing Address - Fax:870-773-1159
Practice Address - Street 1:4115 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1511
Practice Address - Country:US
Practice Address - Phone:870-772-4106
Practice Address - Fax:870-773-1159
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice