Provider Demographics
NPI:1730476078
Name:CARLTON, CHRISTOPHER HALEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:HALEY
Last Name:CARLTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 OLD CANTON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4200
Mailing Address - Country:US
Mailing Address - Phone:601-713-1923
Mailing Address - Fax:601-713-1393
Practice Address - Street 1:3000 OLD CANTON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4200
Practice Address - Country:US
Practice Address - Phone:601-713-1923
Practice Address - Fax:601-713-1393
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3606-111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice