Provider Demographics
NPI:1689000119
Name:CARTTER, JOSHUA WALLACE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:WALLACE
Last Name:CARTTER
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 1:21251 LAKE MATHEWS DR
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-8579
Mailing Address - Country:US
Mailing Address - Phone:951-205-4500
Mailing Address - Fax:
Practice Address - Street 1:328 COMMERCIAL RD
Practice Address - Street 2:#104
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3765
Practice Address - Country:US
Practice Address - Phone:909-799-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist