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General NPI Number Information
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NPI Number | 1679554976
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Entity Type | Individual
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Provider Name | JASON ALLEN CARTER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/14/2005
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 959 MYRTLE AVE
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City | EUREKA
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State | CA
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Zip | 95501-1219
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Country | US
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Telephone | 707-442-7078
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Fax |
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Provider Business Mailing Address
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Address Line | 6603 NE 129TH PL
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City | KIRKLAND
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State | WA
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Zip | 98034-5720
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Country | US
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Telephone | 530-304-3948
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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 | 60288004
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 48090
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License Number State | CA
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