Provider Demographics
NPI:1982750642
Name:CARTER, TOM P (DMD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:P
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 1:1802 ROCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3348
Mailing Address - Country:US
Mailing Address - Phone:270-782-8480
Mailing Address - Fax:
Practice Address - Street 1:1802 ROCKINGHAM AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3348
Practice Address - Country:US
Practice Address - Phone:270-782-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY62551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice