=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639342983
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARTER DAVIS D.D.S. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2008
-----------------------------------------------------
Last Update Date | 04/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5600 W 95TH ST STE 207
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66207-2968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-381-3033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5600 W. 95TH STREET, #207
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-381-3033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CARTER DAVIS
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 913-381-3033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 7150
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------