Provider Demographics
NPI:1306985551
Name:CARRICO, ROBERT ALLEN JR (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLEN
Last Name:CARRICO
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6504 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-2946
Mailing Address - Country:US
Mailing Address - Phone:502-366-4745
Mailing Address - Fax:502-366-8011
Practice Address - Street 1:6504 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2946
Practice Address - Country:US
Practice Address - Phone:502-366-4745
Practice Address - Fax:502-366-8011
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY55061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice