1669807863 NPI number — DR. ANDREA CARRIERI THOMAS DMD

Table of content: DR. ANDREA CARRIERI THOMAS DMD (NPI 1669807863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669807863 NPI number — DR. ANDREA CARRIERI THOMAS DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
ANDREA
Provider Middle Name:
CARRIERI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARRIERI
Provider Other First Name:
ANDREA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669807863
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1519 HERITAGE LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-664-8777
Provider Business Mailing Address Fax Number:
843-667-1925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1519 HERITAGE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-664-8777
Provider Business Practice Location Address Fax Number:
843-667-1925
Provider Enumeration Date:
09/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  8246 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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