Provider Demographics
NPI:1558894113
Name:PAUL CARPINELLO, DMD, MSD, PC
Entity Type:Organization
Organization Name:PAUL CARPINELLO, DMD, MSD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPINELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MSD,PC
Authorized Official - Phone:610-446-6004
Mailing Address - Street 1:1041 PONTIAC RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4816
Mailing Address - Country:US
Mailing Address - Phone:610-446-6004
Mailing Address - Fax:610-446-0459
Practice Address - Street 1:1041 PONTIAC RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4816
Practice Address - Country:US
Practice Address - Phone:610-446-6004
Practice Address - Fax:610-446-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025439L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103118580Medicaid