MEDICARE: JASON ALLEN CARTER D.D.S.

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	1223G0001X	General Practice Dentistry	60288004	WA
2	122300000X	Dentist	48090	CA

General Provider Information

NPI Number	:	1679554976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON ALLEN CARTER D.D.S.

Provider Business Mailing Address
First Line	:	6603 NE 129TH PL
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98034-5720
Country	:	US
Telephone Number	:	530-304-3948
Fax Number	:

Provider Business Practice Location Address
First Line	:	959 MYRTLE AVE
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95501-1219
Country	:	US
Telephone Number	:	707-442-7078
Fax Number	:

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	03/17/2022

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