Provider Demographics
NPI:1952426181
Name:CARTER, RODERICK DAVIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:DAVIS
Last Name:CARTER
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 1:34 OLD IVY RD NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4561
Mailing Address - Country:US
Mailing Address - Phone:404-262-2838
Mailing Address - Fax:404-869-1396
Practice Address - Street 1:34 OLD IVY RD NE
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4561
Practice Address - Country:US
Practice Address - Phone:404-262-2838
Practice Address - Fax:404-869-1396
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice