Provider Demographics
NPI:1770635286
Name:CARTER, JOHN IRVIN (DMD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:IRVIN
Last Name:CARTER
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 1:3615 S FLORIDA AVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4876
Mailing Address - Country:US
Mailing Address - Phone:863-619-6600
Mailing Address - Fax:
Practice Address - Street 1:3615 S FLORIDA AVE
Practice Address - Street 2:SUITE 850
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4876
Practice Address - Country:US
Practice Address - Phone:863-619-6600
Practice Address - Fax:863-619-6644
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN142711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice