Provider Demographics
NPI:1740433184
Name:RICHARD L. CARTER DDS PC
Entity Type:Organization
Organization Name:RICHARD L. CARTER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-591-0750
Mailing Address - Street 1:3204 N ACADEMY BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5165
Mailing Address - Country:US
Mailing Address - Phone:719-591-0750
Mailing Address - Fax:719-380-8764
Practice Address - Street 1:3204 N ACADEMY BLVD
Practice Address - Street 2:STE 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5165
Practice Address - Country:US
Practice Address - Phone:719-591-0750
Practice Address - Fax:719-380-8764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3248261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental