Provider Demographics
NPI:1629101175
Name:CARTER, BRUCE TOLBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:TOLBERT
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 1:125 E STOWELL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6681
Mailing Address - Country:US
Mailing Address - Phone:805-925-8746
Mailing Address - Fax:805-928-0883
Practice Address - Street 1:125 E STOWELL RD STE 101
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6681
Practice Address - Country:US
Practice Address - Phone:805-925-8746
Practice Address - Fax:805-928-0883
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice