Provider Demographics
NPI:1821499542
Name:KISHA CARTER DMD PC
Entity Type:Organization
Organization Name:KISHA CARTER DMD PC
Other - Org Name:BLUSH DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-445-6100
Mailing Address - Street 1:854 CLEVELAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-2920
Mailing Address - Country:US
Mailing Address - Phone:404-445-6100
Mailing Address - Fax:404-601-7777
Practice Address - Street 1:854 CLEVELAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-2920
Practice Address - Country:US
Practice Address - Phone:404-445-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0137221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty