Provider Demographics
NPI:1255781027
Name:CARPENTER, LUCAS (DDS)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:
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 1:2700 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502
Mailing Address - Country:US
Mailing Address - Phone:620-663-8484
Mailing Address - Fax:620-802-0092
Practice Address - Street 1:2700 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502
Practice Address - Country:US
Practice Address - Phone:620-663-8484
Practice Address - Fax:620-802-0092
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016017524122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist