Healthcare Provider Details

I. General information

NPI: 1659582757
Provider Name (Legal Business Name): DAVID CARTER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4352 W SYLVANIA AVE SUITE D
TOLEDO OH
43623-3463
US

IV. Provider business mailing address

4352 W SYLVANIA AVE SUITE D
TOLEDO OH
43623-3463
US

V. Phone/Fax

Practice location:
  • Phone: 419-885-4691
  • Fax:
Mailing address:
  • Phone: 419-885-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD 7911
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number023603
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8714
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: