Provider Demographics
NPI:1407036999
Name:CARPENTER, MATTHEW THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:THOMAS
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:351 W 6TH STREET BLDG 440
Mailing Address - Street 2:USA DENTAC
Mailing Address - City:FT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314
Mailing Address - Country:US
Mailing Address - Phone:912-767-6735
Mailing Address - Fax:912-767-5425
Practice Address - Street 1:351 W 6TH STREET BLDG 440
Practice Address - Street 2:USA DENTAC
Practice Address - City:FT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-767-6735
Practice Address - Fax:912-767-5425
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4409122300000X, 1223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice