Provider Demographics
NPI:1144224411
Name:CARTA, TRIS JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRIS
Middle Name:JOHN
Last Name:CARTA
Suffix:
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 1:152 SADDLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6916
Mailing Address - Country:US
Mailing Address - Phone:860-646-2251
Mailing Address - Fax:
Practice Address - Street 1:192 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5210
Practice Address - Country:US
Practice Address - Phone:860-646-2251
Practice Address - Fax:860-646-7654
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6273122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061100043OtherTIN