Provider Demographics
NPI:1306316104
Name:DOUMIT, CARMEN (BDS, MS, CAGS)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:DOUMIT
Suffix:
Gender:F
Credentials:BDS, MS, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 N BROAD STREET
Mailing Address - Street 2:DEPARTMENT OF ORTHODONTICS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140
Mailing Address - Country:US
Mailing Address - Phone:215-707-2314
Mailing Address - Fax:
Practice Address - Street 1:3223 N BROAD STREET
Practice Address - Street 2:TEMPLE UNIVERSITY DEPARTMENT OF ORTHODONTICS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140
Practice Address - Country:US
Practice Address - Phone:215-707-2314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARFD0000211223X0400X
PADS0433301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics