Provider Demographics
NPI:1417952763
Name:HALLMARK, CARTER LEROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARTER
Middle Name:LEROY
Last Name:HALLMARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-3827
Mailing Address - Country:US
Mailing Address - Phone:972-790-4568
Mailing Address - Fax:972-259-2809
Practice Address - Street 1:1111 S MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-3827
Practice Address - Country:US
Practice Address - Phone:972-790-4568
Practice Address - Fax:972-259-2809
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice