Provider Demographics
NPI:1841339942
Name:CARTER, PHILIP (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
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 1:9245 POPLAR AVE
Mailing Address - Street 2:SUITE 8-161
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4250 FARONIA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6527
Practice Address - Country:US
Practice Address - Phone:901-414-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN87261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5442018Medicaid