Healthcare Provider Details

I. General information

NPI: 1881670743
Provider Name (Legal Business Name): WILLIAM MANN CARTER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 HAMMOND ST
BISHOP CA
93514-2627
US

IV. Provider business mailing address

537 HAMMOND ST
BISHOP CA
93514-2627
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-6066
  • Fax: 202-782-9195
Mailing address:
  • Phone: 760-873-6066
  • Fax: 202-782-9195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number49734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: