Healthcare Provider Details

I. General information

NPI: 1619949328
Provider Name (Legal Business Name): JEFFREY LEE CARTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MAIN STREET
DEER RIVER MN
56636
US

IV. Provider business mailing address

PO BOX 40
DEER RIVER MN
56636
US

V. Phone/Fax

Practice location:
  • Phone: 218-246-8200
  • Fax: 218-246-8982
Mailing address:
  • Phone: 218-246-8200
  • Fax: 218-246-8982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9499
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: