Provider Demographics
NPI:1629061197
Name:CARTER, CRAIG M (DDS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
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:PO BOX 140
Mailing Address - Street 2:912 16TH AVE
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-0140
Mailing Address - Country:US
Mailing Address - Phone:608-325-6661
Mailing Address - Fax:608-329-4361
Practice Address - Street 1:912 16TH AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1762
Practice Address - Country:US
Practice Address - Phone:608-325-6661
Practice Address - Fax:608-329-4361
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
WI0003142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33452600Medicaid