Healthcare Provider Details

I. General information

NPI: 1811086887
Provider Name (Legal Business Name): WINTHROP B. CARTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 SW CAMPUS DRIVE OHSU SCHOOL OF DENTISTRY, SD 177
PORTLAND OR
97239
US

IV. Provider business mailing address

8528 NW GILLIAM LN
PORTLAND OR
97229-9188
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8874
  • Fax: 503-418-2001
Mailing address:
  • Phone: 503-297-5691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD8174
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: