Provider Demographics
NPI:1356182950
Name:CARPENTER, COLE (DMD)
Entity type:Individual
Prefix:DR
First Name:COLE
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 COASTAL COVE CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0004
Mailing Address - Country:US
Mailing Address - Phone:315-767-3181
Mailing Address - Fax:
Practice Address - Street 1:5911 TIMUQUANA RD STE 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8174
Practice Address - Country:US
Practice Address - Phone:904-864-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist