Provider Demographics
NPI:1548248859
Name:CARTER, TIMOTHY CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHARLES
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 1:418 SAVANNAH TRACE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5442
Mailing Address - Country:US
Mailing Address - Phone:931-614-6603
Mailing Address - Fax:931-614-6668
Practice Address - Street 1:418 SAVANNAH TRACE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5442
Practice Address - Country:US
Practice Address - Phone:931-614-6603
Practice Address - Fax:931-614-6668
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86981223P0300X
TN87591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics