Healthcare Provider Details

I. General information

NPI: 1902809833
Provider Name (Legal Business Name): CHARLES J MCCARTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10438 OLIO ROAD
FORTVILLE IN
46040-7500
US

IV. Provider business mailing address

10438 OLIO ROAD
FORTVILLE IN
46040-7500
US

V. Phone/Fax

Practice location:
  • Phone: 317-336-9922
  • Fax: 317-336-9925
Mailing address:
  • Phone: 317-336-9922
  • Fax: 317-336-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12009132A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12009132
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: