Provider Demographics
NPI:1629071915
Name:CARPENTER, DAVE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVE
Middle Name:S
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 DELAWARE STE.
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706
Mailing Address - Country:US
Mailing Address - Phone:409-898-4300
Mailing Address - Fax:409-898-2777
Practice Address - Street 1:3560 DELAWARE ST
Practice Address - Street 2:STE 1003
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3026
Practice Address - Country:US
Practice Address - Phone:409-898-4300
Practice Address - Fax:409-898-2777
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice