Provider Demographics
NPI:1912346008
Name:CARTER, RYAN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:D
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 5682
Mailing Address - Street 2:
Mailing Address - City:LK MONTEZUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:86342-5682
Mailing Address - Country:US
Mailing Address - Phone:928-202-4787
Mailing Address - Fax:918-872-7147
Practice Address - Street 1:4283 N. PIMA WAY
Practice Address - Street 2:
Practice Address - City:LAKE MONTEZUMA
Practice Address - State:AZ
Practice Address - Zip Code:86342-8634
Practice Address - Country:US
Practice Address - Phone:480-734-9784
Practice Address - Fax:918-872-7147
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist