MEDICARE: RICHARD L. CARTER DDS 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	261QD0000X	Dental Clinic/Center	3248	CO

General Provider Information

NPI Number	:	1740433184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD L. CARTER DDS PC

Provider Business Mailing Address
First Line	:	3204 N ACADEMY BLVD
Second Line	:	STE 210
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5165
Country	:	US
Telephone Number	:	719-591-0750
Fax Number	:	719-380-8764

Provider Business Practice Location Address
First Line	:	3204 N ACADEMY BLVD
Second Line	:	STE 210
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5165
Country	:	US
Telephone Number	:	719-591-0750
Fax Number	:	719-380-8764

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD LEE CARTER
Credential	:	DDS
Telephone Number	:	719-591-0750

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	10/29/2008

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