Provider Demographics
NPI:1831106137
Name:CARPENTER, VANESSA GALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:GALE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7002 MCPHERSON
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6442
Mailing Address - Country:US
Mailing Address - Phone:956-725-5035
Mailing Address - Fax:956-717-4106
Practice Address - Street 1:7002 MCPHERSON
Practice Address - Street 2:SUITE 104
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6442
Practice Address - Country:US
Practice Address - Phone:956-725-5035
Practice Address - Fax:956-717-4106
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice