Active NPI
Ryan D Carter, DDS
- Dentist
- Lake Montezuma, AZ
National Provider Identifier
1912346008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D009128
- Practice address
- 4283 N. Pima Way
Lake Montezuma, AZ 86342-8634 - Phone
- (480) 734-9784
- Fax
- (918) 872-7147
- NPI assigned
- Jun 21, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D009128 | AZ | Primary |
Addresses
Primary practice location
4283 N. Pima Way
Lake Montezuma, AZ 86342-8634
Mailing address
PO Box 5682
LK Montezuma, AZ 86342-5682
Phone (928) 202-4787
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D009128 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Copper Canyon Family Dental | General Practice | Past | Accepting new patients |
| Montezuma Family Dental | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Lake Montezuma, AZ
- NPI 1992171532
-
- General Practice Dentistry
- Camp Verde, AZ
- NPI 1447814199
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546473600000",
"number": "1912346008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5682",
"city": "LK MONTEZUMA",
"state": "AZ",
"postal_code": "863425682",
"telephone_number": "928-202-4787",
"fax_number": "918-872-7147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4283 N. PIMA WAY",
"city": "LAKE MONTEZUMA",
"state": "AZ",
"postal_code": "863428634",
"telephone_number": "480-734-9784",
"fax_number": "918-872-7147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARTER",
"first_name": "RYAN",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-06-21",
"last_updated": "2019-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D009128",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Montezuma, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.