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General NPI Number Information
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NPI Number | 1689000119
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Entity Type | Individual
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Provider Name | JOSHUA WALLACE CARTTER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 328 COMMERCIAL RD #104
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3765
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Country | US
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Telephone | 909-799-9988
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Fax |
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Provider Business Mailing Address
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Address Line | 21251 LAKE MATHEWS DR
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City | PERRIS
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State | CA
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Zip | 92570-8579
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Country | US
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Telephone | 951-205-4500
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 59057
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License Number State | CA
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