Provider Demographics
NPI:1306058656
Name:CARR, PATRICK ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ANDREW
Last Name:CARR
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 1:1617 W GARDENIA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7937
Mailing Address - Country:US
Mailing Address - Phone:602-647-4756
Mailing Address - Fax:623-933-0468
Practice Address - Street 1:10333 W COGGINS DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3408
Practice Address - Country:US
Practice Address - Phone:623-933-0078
Practice Address - Fax:623-933-0468
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3351122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist