Healthcare Provider Details

I. General information

NPI: 1548575970
Provider Name (Legal Business Name): ANTHONY JERRARD CARTER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W YAMATO RD STE A4
BOCA RATON FL
33431-4428
US

IV. Provider business mailing address

1280 MANOR DR S
WESTON FL
33326-2824
US

V. Phone/Fax

Practice location:
  • Phone: 561-997-9930
  • Fax:
Mailing address:
  • Phone: 954-232-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14552
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number058318
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number14552
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN24590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: