Provider Demographics
NPI:1992171532
Name:MONTEZUMA FAMILY DENTAL
Entity type:Organization
Organization Name:MONTEZUMA FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-202-4787
Mailing Address - Street 1:PO BOX 5682
Mailing Address - Street 2:
Mailing Address - City:LAKE MONTEZUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:86342-5682
Mailing Address - Country:US
Mailing Address - Phone:928-202-4787
Mailing Address - Fax:928-233-6904
Practice Address - Street 1:4283 N PIMA WAY
Practice Address - Street 2:
Practice Address - City:LAKE MONTEZUMA
Practice Address - State:AZ
Practice Address - Zip Code:86342
Practice Address - Country:US
Practice Address - Phone:928-202-4787
Practice Address - Fax:928-233-6904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty