Provider Demographics
NPI:1093045387
Name:CARPENTER, KENNETH E (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
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 1:1121 E STADIUM BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4615
Mailing Address - Country:US
Mailing Address - Phone:734-662-6772
Mailing Address - Fax:734-662-7973
Practice Address - Street 1:1121 E STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4615
Practice Address - Country:US
Practice Address - Phone:734-662-6772
Practice Address - Fax:734-662-7973
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9401122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist