Provider Demographics
NPI:1033322367
Name:CRAIG M. CARTER D.D.S., S.C.
Entity Type:Organization
Organization Name:CRAIG M. CARTER D.D.S., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-325-6661
Mailing Address - Street 1:912 16TH AVE
Mailing Address - Street 2:P.O. BOX 140
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1762
Mailing Address - Country:US
Mailing Address - Phone:608-325-6661
Mailing Address - Fax:608-329-4361
Practice Address - Street 1:912 16TH AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1762
Practice Address - Country:US
Practice Address - Phone:608-325-6661
Practice Address - Fax:608-329-4361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33452600Medicaid