Provider Demographics
NPI:1326474370
Name:ESTEY AND CARPENTER DENTAL CORPORATION
Entity Type:Organization
Organization Name:ESTEY AND CARPENTER DENTAL CORPORATION
Other - Org Name:ESTEY & CARPENTER FAMILY DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-335-1166
Mailing Address - Street 1:1806 ORANGE TREE LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4569
Mailing Address - Country:US
Mailing Address - Phone:909-335-1166
Mailing Address - Fax:909-335-1166
Practice Address - Street 1:1806 ORANGE TREE LN
Practice Address - Street 2:SUITE B
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4569
Practice Address - Country:US
Practice Address - Phone:909-335-1166
Practice Address - Fax:909-335-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45230122300000X
CA45253122300000X
CA28847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty