=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538869680
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARTER ULRICH DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2023
-----------------------------------------------------
Last Update Date | 08/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7321 BALMER ST BLDG 570
-----------------------------------------------------
City | HILL AFB
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84056-5012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-721-0419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7321 BALMER ST BLDG 570
-----------------------------------------------------
City | HILL AFB
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84056-5012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 12014145A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------