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General NPI Number Information
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NPI Number | 1194021022
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Entity Type | Organization
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Legal Business Name | CARLTON FAMILY DENTISTRY
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Dates
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Enumeration Date | 02/10/2011
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Last Update Date | 11/30/2015
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Provider Practice Location Address
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Address Line | 323 HIGHLAND BLVD
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City | NATCHEZ
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State | MS
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Zip | 39120-4635
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Country | US
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Telephone | 601-653-0003
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Fax |
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Provider Business Mailing Address
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Address Line | 323 HIGHLAND BLVD
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City | NATCHEZ
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State | MS
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Zip | 39120-4635
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Country | US
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Telephone | 601-653-0003
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. JOHN BALLEW CARLTON
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Credential | D.M.D.
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Telephone | 601-653-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3503-09
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License Number State | MS
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