Provider Demographics
NPI:1598700163
Name:CARPENTER, III, CLEVELAND COLUMBUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLEVELAND
Middle Name:COLUMBUS
Last Name:CARPENTER, III
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8913 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2814
Mailing Address - Country:US
Mailing Address - Phone:225-766-7379
Mailing Address - Fax:225-766-4784
Practice Address - Street 1:8913 BLUEBONNET BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2814
Practice Address - Country:US
Practice Address - Phone:225-766-7379
Practice Address - Fax:225-766-4784
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice