Individual
CARSON VAN ETTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
18511 HIGHLANDER MEDICS ST, FORT BLISS, TX 79918
(337) 531-2603
Mailing address
14693 OLDENBERG CT, EL PASO, TX 79938-1013
(904) 335-7597
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
37875
TX
Other
Enumeration date
10/22/2021
Last updated
10/22/2021
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