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General NPI Number Information
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NPI Number | 1093407082
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Entity Type | Individual
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Provider Name | KENNETH CORDELL CARTER DDS
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Gender | Male
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 227 N HAMMES AVE
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City | JOLIET
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State | IL
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Zip | 60435-8115
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Country | US
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Telephone | 815-653-8050
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Fax |
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Provider Business Mailing Address
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Address Line | 2255 RIDGE RD
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City | LANSING
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State | IL
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Zip | 60438-2625
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Country | US
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Telephone | 773-812-4421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.034203
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License Number State | IL
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