Healthcare Provider Details

I. General information

NPI: 1033762877
Provider Name (Legal Business Name): ITAMAR CARTER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 W MERRICK RD STE 11
FREEPORT NY
11520-3396
US

IV. Provider business mailing address

294 W MERRICK RD STE 11
FREEPORT NY
11520-3396
US

V. Phone/Fax

Practice location:
  • Phone: 516-378-4140
  • Fax: 516-378-4529
Mailing address:
  • Phone: 516-378-4140
  • Fax: 516-378-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number061560
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: