Provider Demographics
NPI:1275789356
Name:CARPENTER, MATTHEW RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RAYMOND
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 1:12075 CARMEL MOUNTAIN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4613
Mailing Address - Country:US
Mailing Address - Phone:858-487-6453
Mailing Address - Fax:858-487-6474
Practice Address - Street 1:12075 CARMEL MOUNTAIN RD STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4613
Practice Address - Country:US
Practice Address - Phone:858-487-6453
Practice Address - Fax:858-487-6717
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist