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General NPI Number Information
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NPI Number | 1538263132
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Entity Type | Individual
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Provider Name | ELLEN PHYLLIS CARTER DDS
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Gender | Female
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 5180 PARK AVE STE #260
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City | MEMPHIS
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State | TN
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Zip | 38119
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Country | US
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Telephone | 901-683-5827
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Fax | 901-766-1640
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Provider Business Mailing Address
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Address Line | 5180 PARK AVE STE #260
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City | MEMPHIS
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State | TN
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Zip | 38119
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Country | US
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Telephone | 901-683-5827
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Fax | 901-766-1640
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS4082
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License Number State | TN
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