Provider Demographics
NPI:1053731737
Name:CARBERRY, ANNIE KRISTIN (DDS)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:KRISTIN
Last Name:CARBERRY
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 1:201 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1417
Mailing Address - Country:US
Mailing Address - Phone:704-376-6470
Mailing Address - Fax:704-496-2988
Practice Address - Street 1:201 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1417
Practice Address - Country:US
Practice Address - Phone:704-376-6470
Practice Address - Fax:704-496-2988
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9712122300000X
CA64689122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist