MEDICARE: DR BARNEY W CARTER DMD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist		NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154838266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR BARNEY W CARTER DMD PC

Provider Business Mailing Address
First Line	:	3900 EUBANK BLVD NE STE 19
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3427
Country	:	US
Telephone Number	:	505-299-1714
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 EUBANK BLVD NE STE 19
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3427
Country	:	US
Telephone Number	:	505-299-1714
Fax Number	:	505-299-0018

Authorized Official
Title or Position	:	OFFICE ADMIN
Name	:	MS. RACHAEL CHRISTINE SEVERINGHAUS
Credential	:
Telephone Number	:	505-299-1714

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	01/10/2018

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