Provider Demographics
NPI:1114094513
Name:CARTER, RANDALL MONTE II (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:MONTE
Last Name:CARTER
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 53RD AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:37207-3412
Mailing Address - Country:US
Mailing Address - Phone:941-739-2088
Mailing Address - Fax:941-739-2872
Practice Address - Street 1:218 53RD AVENUE WEST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:37207-3412
Practice Address - Country:US
Practice Address - Phone:941-739-2088
Practice Address - Fax:941-739-2872
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist