Individual
LUIS CARRAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
800 M 139, BENTON HARBOR, MI 49022-3881
(855) 869-6900
(269) 427-5180
Mailing address
50 INDUSTRIAL PARK RD, BANGOR, MI 49013-1246
(269) 427-7937
(269) 427-5180
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901022828
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MI
Enumeration date
10/02/2018
Last updated
10/03/2018
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