Provider Demographics
NPI:1578653606
Name:CARTER, STEVEN WYATT (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WYATT
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 1:2025 W HWY 50
Mailing Address - Street 2:A-100
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008
Mailing Address - Country:US
Mailing Address - Phone:719-542-2472
Mailing Address - Fax:719-542-6435
Practice Address - Street 1:2025 W HWY 50
Practice Address - Street 2:A-100
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008
Practice Address - Country:US
Practice Address - Phone:719-542-2472
Practice Address - Fax:719-542-6435
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO70441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice