Provider Demographics
NPI:1811325665
Name:CARTER, DENNIS LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LEE
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:PO BOX 1532
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46634-1532
Mailing Address - Country:US
Mailing Address - Phone:574-250-7039
Mailing Address - Fax:
Practice Address - Street 1:53360 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1354
Practice Address - Country:US
Practice Address - Phone:574-250-7039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006926A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist