Provider Demographics
NPI:1578661666
Name:CARTER, BERNACE MICHAEL
Entity type:Individual
Prefix:DR
First Name:BERNACE
Middle Name:MICHAEL
Last Name:CARTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HERONS CV
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-7702
Mailing Address - Country:US
Mailing Address - Phone:601-955-8123
Mailing Address - Fax:
Practice Address - Street 1:115 W JACKSON ST STE 1C
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2428
Practice Address - Country:US
Practice Address - Phone:769-567-1000
Practice Address - Fax:769-567-1939
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS182579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist