Provider Demographics
NPI:1710370176
Name:MIKE CARPENTER, DDS
Entity Type:Organization
Organization Name:MIKE CARPENTER, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUEHRS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-443-1703
Mailing Address - Street 1:3093 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3151
Mailing Address - Country:US
Mailing Address - Phone:303-443-1703
Mailing Address - Fax:
Practice Address - Street 1:3093 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3151
Practice Address - Country:US
Practice Address - Phone:303-443-1703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty