MEDICARE: DR. RYAN D CARTER DDS

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	D009128	AZ

General Provider Information

NPI Number	:	1912346008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN D CARTER DDS

Provider Business Mailing Address
First Line	:	PO BOX 5682
Second Line	:
City	:	LK MONTEZUMA
State	:	AZ
Zip	:	86342-5682
Country	:	US
Telephone Number	:	928-202-4787
Fax Number	:	918-872-7147

Provider Business Practice Location Address
First Line	:	4283 N. PIMA WAY
Second Line	:
City	:	LAKE MONTEZUMA
State	:	AZ
Zip	:	86342-8634
Country	:	US
Telephone Number	:	480-734-9784
Fax Number	:	918-872-7147

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

Provider Enumeration Date	:	06/21/2013
Last Update Date	:	01/03/2019

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Directions to “ DR. RYAN D CARTER DDS” Practice Location

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