Healthcare Provider Details

I. General information

NPI: 1760317440
Provider Name (Legal Business Name): KYLE P CARTER DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 WILLOW CREEK RD
PRESCOTT AZ
86301-1427
US

IV. Provider business mailing address

1229 WILLOW CREEK RD
PRESCOTT AZ
86301-1427
US

V. Phone/Fax

Practice location:
  • Phone: 928-778-4110
  • Fax: 928-778-4114
Mailing address:
  • Phone: 928-778-4110
  • Fax: 928-778-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KYLE CARTER
Title or Position: OWNER
Credential: DMD
Phone: 928-778-4110