Provider Demographics
NPI:1407585995
Name:BRIAN K CARPENTER DDS
Entity Type:Organization
Organization Name:BRIAN K CARPENTER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-949-2591
Mailing Address - Street 1:6521 SCARBOROUGH DR SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9144
Mailing Address - Country:US
Mailing Address - Phone:616-949-2591
Mailing Address - Fax:
Practice Address - Street 1:2750 BRETON RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8052
Practice Address - Country:US
Practice Address - Phone:616-949-2591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental