Healthcare Provider Details

I. General information

NPI: 1922453000
Provider Name (Legal Business Name): KEVIN CARTER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 BOUNDRY LN
BEAVER PA
15009-2949
US

IV. Provider business mailing address

97 BOUNDRY LN
BEAVER PA
15009-2949
US

V. Phone/Fax

Practice location:
  • Phone: 724-728-0970
  • Fax:
Mailing address:
  • Phone: 740-773-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS044840
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: