Provider Demographics
NPI:1154838266
Name:DR BARNEY W CARTER DMD PC
Entity Type:Organization
Organization Name:DR BARNEY W CARTER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:SEVERINGHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-299-1714
Mailing Address - Street 1:3900 EUBANK BLVD NE STE 19
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3427
Mailing Address - Country:US
Mailing Address - Phone:505-299-1714
Mailing Address - Fax:
Practice Address - Street 1:3900 EUBANK BLVD NE STE 19
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3427
Practice Address - Country:US
Practice Address - Phone:505-299-1714
Practice Address - Fax:505-299-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM97573018Medicaid