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General NPI Number Information
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NPI Number | 1982989117
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Entity Type | Organization
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Legal Business Name | CARTHAGE DENTAL CENTER
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 401 N ADAMS ST
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City | CARTHAGE
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State | TX
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Zip | 75633-1311
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Country | US
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Telephone | 903-693-8500
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Fax | 903-693-8501
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Provider Business Mailing Address
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Address Line | 401 N ADAMS ST
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City | CARTHAGE
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State | TX
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Zip | 75633-1311
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Country | US
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Telephone | 903-693-8500
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Fax | 903-693-8501
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Authorized Official
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Title or Position | OWNER
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Name | KIM FOWLER
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Credential | RDH
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Telephone | 903-693-8500
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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 | 11803
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License Number State | TX
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