Provider Demographics
NPI:1578640009
Name:CARPENTER, CHAD (DDS,PC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 W MAIN ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-0901
Mailing Address - Country:US
Mailing Address - Phone:605-342-5995
Mailing Address - Fax:
Practice Address - Street 1:2525 W MAIN ST
Practice Address - Street 2:SUITE 307
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0901
Practice Address - Country:US
Practice Address - Phone:605-342-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD05041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice