Provider Demographics
NPI:1346229804
Name:CARTER, JOHN LAWERENCE III
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LAWERENCE
Last Name:CARTER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W WACKERLY ST
Mailing Address - Street 2:SUITE 3900
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4722
Mailing Address - Country:US
Mailing Address - Phone:989-631-8040
Mailing Address - Fax:989-839-8880
Practice Address - Street 1:555 W WACKERLY ST
Practice Address - Street 2:SUITE 3900
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4722
Practice Address - Country:US
Practice Address - Phone:989-631-8040
Practice Address - Fax:989-839-8880
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI110161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382192910OtherTIN