Provider Demographics
NPI:1023122868
Name:MCCARTER, VAN BURWELL (DDS)
Entity type:Individual
Prefix:DR
First Name:VAN
Middle Name:BURWELL
Last Name:MCCARTER
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 1:105 E CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-3838
Mailing Address - Country:US
Mailing Address - Phone:540-387-5530
Mailing Address - Fax:
Practice Address - Street 1:105 E CALHOUN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-3838
Practice Address - Country:US
Practice Address - Phone:540-387-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010056941223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008410OtherDORAL I.D. NUMBER