Provider Demographics
NPI:1659452480
Name:ANDREW J CARTER DDS PC
Entity Type:Organization
Organization Name:ANDREW J CARTER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:334-792-5124
Mailing Address - Street 1:206 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303
Mailing Address - Country:US
Mailing Address - Phone:334-792-5124
Mailing Address - Fax:334-793-2049
Practice Address - Street 1:206 EXECUTIVE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303
Practice Address - Country:US
Practice Address - Phone:334-792-5124
Practice Address - Fax:334-793-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3090OtherLICENSE
91054OtherBLUE CROSS BLUE SHIELD
3090OtherDELTA DENTAL
619800OtherUNITED CORCORDIA