Provider Demographics
NPI:1245466242
Name:CARLTON, JOHN BALLEW (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BALLEW
Last Name:CARLTON
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 1:2 MANDAMUS PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-8606
Mailing Address - Country:US
Mailing Address - Phone:601-442-3906
Mailing Address - Fax:
Practice Address - Street 1:20 HOBO FORK RD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-9025
Practice Address - Country:US
Practice Address - Phone:601-304-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3503-091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice