Provider Demographics
NPI:1669675724
Name:CHAD M. CARPENTER DDS
Entity Type:Organization
Organization Name:CHAD M. CARPENTER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:605-342-5995
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD050425251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty