Provider Demographics
NPI:1881857142
Name:CENTER FOR ORAL AND MAXILLOFACIAL SURGERY, JOE L. CARPENTER, DMD, INC.
Entity Type:Organization
Organization Name:CENTER FOR ORAL AND MAXILLOFACIAL SURGERY, JOE L. CARPENTER, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:I
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-498-9920
Mailing Address - Street 1:6653 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7259
Mailing Address - Country:US
Mailing Address - Phone:330-498-9920
Mailing Address - Fax:330-498-9921
Practice Address - Street 1:6653 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7259
Practice Address - Country:US
Practice Address - Phone:330-498-9920
Practice Address - Fax:330-498-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCE0677323Medicare PIN