Provider Demographics
NPI:1518206127
Name:CARTER, JOHN ADAM (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ADAM
Last Name:CARTER
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 1:1620 E RIVERSIDE DR
Mailing Address - Street 2:APT 2074
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-1008
Mailing Address - Country:US
Mailing Address - Phone:936-465-4844
Mailing Address - Fax:
Practice Address - Street 1:1620 E RIVERSIDE DR
Practice Address - Street 2:APT 2074
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-1008
Practice Address - Country:US
Practice Address - Phone:936-465-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist