Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 12269 | TX |
NPI | 1083707970 |
---|---|
Provider Name | John David Carter |
First Address | Tyler, TX 75701 |
Second Address | Tyler, TX 75701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |