Provider Demographics
NPI:1992243901
Name:CARRICK DENTISTRY, P.A.
Entity type:Organization
Organization Name:CARRICK DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTRIX OF JOE CARRICK ESTATE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-795-0199
Mailing Address - Street 1:1805 W WHITE OAK TER
Mailing Address - Street 2:STE. D
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3456
Mailing Address - Country:US
Mailing Address - Phone:936-828-0676
Mailing Address - Fax:936-494-0683
Practice Address - Street 1:1805 W WHITE OAK TER
Practice Address - Street 2:STE. D
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3456
Practice Address - Country:US
Practice Address - Phone:936-828-0676
Practice Address - Fax:936-494-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental