Provider Demographics
NPI:1801632070
Name:MAUGHAN, CARTER BURKE (DMD)
Entity type:Individual
Prefix:DR
First Name:CARTER
Middle Name:BURKE
Last Name:MAUGHAN
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 1:1009 FENTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7613
Mailing Address - Country:US
Mailing Address - Phone:480-267-0517
Mailing Address - Fax:
Practice Address - Street 1:1009 FENTON PARK DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7613
Practice Address - Country:US
Practice Address - Phone:480-267-0517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024025432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist