Provider Demographics
NPI:1568839850
Name:CARPENTER DENTAL CHARLES M. CARPENTER CHARLES M. CARPENTER JR. P.C.
Entity Type:Organization
Organization Name:CARPENTER DENTAL CHARLES M. CARPENTER CHARLES M. CARPENTER JR. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-331-0909
Mailing Address - Street 1:1086 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4014
Mailing Address - Country:US
Mailing Address - Phone:570-331-0909
Mailing Address - Fax:570-714-5184
Practice Address - Street 1:1086 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4014
Practice Address - Country:US
Practice Address - Phone:570-331-0909
Practice Address - Fax:570-714-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty