Provider Demographics
NPI:1972662435
Name:CARPENTER, RICHARD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 SPRING ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2708
Mailing Address - Country:US
Mailing Address - Phone:517-787-6982
Mailing Address - Fax:
Practice Address - Street 1:761 W MICHIGAN AVE
Practice Address - Street 2:STE C
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1995
Practice Address - Country:US
Practice Address - Phone:517-789-8622
Practice Address - Fax:517-789-8636
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI112751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice