Provider Demographics
NPI:1023217247
Name:CARPENTER, MICHAEL DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEAN
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 WESTMORELAND AVE.
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545
Mailing Address - Country:US
Mailing Address - Phone:419-592-9956
Mailing Address - Fax:419-592-9855
Practice Address - Street 1:610 BROADMOOR AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1288
Practice Address - Country:US
Practice Address - Phone:419-592-9956
Practice Address - Fax:419-592-9855
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0204851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice