Provider Demographics
NPI:1306004288
Name:CARTER, KISHA NICOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KISHA
Middle Name:NICOLE
Last Name:CARTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 CLEVELAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-2920
Mailing Address - Country:US
Mailing Address - Phone:404-445-6100
Mailing Address - Fax:
Practice Address - Street 1:854 CLEVELAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-2920
Practice Address - Country:US
Practice Address - Phone:404-445-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0137221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice