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General NPI Number Information
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NPI Number | 1457580664
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Entity Type | Individual
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Provider Name | SCOTT BRANDON CARTER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 1459 LANEY WALKER BLVD SCHOOL OF DENTISTRY AD 2507
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City | AUGUSTA
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State | GA
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Zip | 30912-0002
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Country | US
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Telephone | 706-721-4025
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 ALEXANDER DR APT 6223
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City | AUGUSTA
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State | GA
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Zip | 30909-0288
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Country | US
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Telephone | 770-403-3840
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN013942
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License Number State | GA
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