Provider Demographics
NPI:1952462319
Name:DAN W CHARPENTIER DDS PC
Entity Type:Organization
Organization Name:DAN W CHARPENTIER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHARPENTIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-878-1114
Mailing Address - Street 1:14377 WOODLAKE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-878-1114
Mailing Address - Fax:314-878-8681
Practice Address - Street 1:14377 WOODLAKE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-878-1114
Practice Address - Fax:314-878-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO014668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty