Healthcare Provider Details

I. General information

NPI: 1679554976
Provider Name (Legal Business Name): JASON ALLEN CARTER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 MYRTLE AVE
EUREKA CA
95501-1219
US

IV. Provider business mailing address

6603 NE 129TH PL
KIRKLAND WA
98034-5720
US

V. Phone/Fax

Practice location:
  • Phone: 707-442-7078
  • Fax:
Mailing address:
  • Phone: 530-304-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60288004
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number48090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: