Provider Demographics
NPI:1699355925
Name:CARPENTER, PRISCILLA LEE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:LEE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14109 GLASWICK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8668
Mailing Address - Country:US
Mailing Address - Phone:704-222-8800
Mailing Address - Fax:
Practice Address - Street 1:8912 BLAKENEY PROFESSIONAL DR STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6735
Practice Address - Country:US
Practice Address - Phone:980-833-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRPM23391223E0200X
NC131571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics