Provider Demographics
NPI:1053735571
Name:CARMONA, DAVID (DDS, MS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CARMONA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 NW 118TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8072
Mailing Address - Country:US
Mailing Address - Phone:954-603-6336
Mailing Address - Fax:
Practice Address - Street 1:11903 SOUTHERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7644
Practice Address - Country:US
Practice Address - Phone:561-459-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN204991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics