Provider Demographics
NPI:1679671655
Name:CARPENTER, ARTHUR B (DDS LTD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:B
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DDS LTD
Other - Prefix:
Other - First Name:ART
Other - Middle Name:
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS LTD
Mailing Address - Street 1:450 A GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60043
Mailing Address - Country:US
Mailing Address - Phone:847-251-5004
Mailing Address - Fax:847-251-7418
Practice Address - Street 1:450 A GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:IL
Practice Address - Zip Code:60043
Practice Address - Country:US
Practice Address - Phone:847-251-5004
Practice Address - Fax:847-251-7418
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice