MEDICARE: DR. CAMERON SAMUEL CARTER DMD

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	41320	TX

General Provider Information

NPI Number	:	1427848563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMERON SAMUEL CARTER DMD

Provider Business Mailing Address
First Line	:	600 E SOUTHLAKE BLVD
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6254
Country	:	US
Telephone Number	:	817-488-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 E SOUTHLAKE BLVD
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6254
Country	:	US
Telephone Number	:	817-488-2273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	05/12/2025

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