# CARTER DENTAL, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366619694
- **Authorized official:** DR. W JASON CARTER DDS (OWNER/DENTIST)
- **Authorized official phone:** (208) 376-6346

## Contact information

- **Practice address:** 7878 USTICK RD STE 102, BOISE, ID 83704-5006
- **Practice address phone:** (208) 376-6346
- **Practice address fax:** (208) 246-0508
- **Mailing address:** 7878 USTICK RD STE 102, BOISE, ID 83704-5006
- **Mailing address phone:** (208) 376-6346
- **Mailing address fax:** (208) 246-0508

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D1401 | ID | — |
| 1223G0001X | General Practice Dentistry | D3384 | ID | Yes |
| 1223G0001X | General Practice Dentistry | D3693 | ID | — |

## Other

- **Enumeration date:** 05/15/2008
- **Last updated:** 05/15/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 434421 | UNITED CONCORDIA | PA |
| 01 | — | 6I047 | BLUE CROSS OF IDAHO | ID |