David Joseph Carbonell, DDS
Individual provider Active NPI Dentist · Bridgman, MI
NPI 1205249786 · NPPES record last updated Jun 3, 2014
Key facts
- NPI
- 1205249786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2901020835 (MI)
- Practice address
- 9500 Red Arrow Hwy
Bridgman, MI 49106-9593 - Phone
- (269) 465-3001
- NPI assigned
- Jun 3, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160314000545 | MI | Order and Referring Only - Dentist |
7113223413 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Buck'S Treasure PLLC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901020835 | MI | Yes |
Addresses
Primary practice location
9500 Red Arrow Hwy
Bridgman, MI 49106-9593
Mailing address
PO Box 748
Bridgman, MI 49106-0748
Phone (269) 465-3001
Other providers in Bridgman, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.