Individual provider Active NPI

Michael Alan Carl, D.D.S.

  • Dentist
  • Lodi, CA
National Provider Identifier
1285731232
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
32696 Issued in CA
Practice address
1930 Tienda Dr
Suite 203
Lodi, CA 95242-3933
Phone
(209) 369-2862
Fax
(209) 369-1136
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 32696 CA Primary

Addresses

Primary practice location

1930 Tienda Dr
Suite 203
Lodi, CA 95242-3933

Mailing address

1930 Tienda Dr
Suite 203
Lodi, CA 95242-3933
Phone (209) 369-2862

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161216000327 CA Order and Referring Only - DentistPractitioner - Dentist 4183904790

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
32696CAMDPhysical Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285731232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 TIENDA DR",
            "address_2": "SUITE 203",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952423933",
            "telephone_number": "209-369-2862",
            "fax_number": "209-369-1136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 TIENDA DR",
            "address_2": "SUITE 203",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952423933",
            "telephone_number": "209-369-2862",
            "fax_number": "209-369-1136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARL",
        "first_name": "MICHAEL",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "32696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, CA

Sources for this page

Verify at the official NPI Registry.