Provider Demographics
NPI:1790759785
Name:CARTER, DERRICK RICHIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:RICHIE
Last Name:CARTER
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:FLUGPLATZ ERBENHEIM BLDG 1040, 65205 WIESBADEN
Mailing Address - Street 2:CMR 467
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09096
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUHL DENTAC
Practice Address - Street 2:MARCEAU KASERNE BLDG 3703 RM 205
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:0637-192-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice