Provider Demographics
NPI:1992122139
Name:CARNEY, EILEEN M (DDS)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:CARNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35104 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4516
Mailing Address - Country:US
Mailing Address - Phone:440-942-0994
Mailing Address - Fax:440-942-3569
Practice Address - Street 1:35104 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4516
Practice Address - Country:US
Practice Address - Phone:440-942-0994
Practice Address - Fax:440-942-3569
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30018673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist