Provider Demographics
NPI:1831164466
Name:CARPENTER, JOE L (DMD)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:L
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 1:4774 MUNSON ST. NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718
Mailing Address - Country:US
Mailing Address - Phone:330-494-6653
Mailing Address - Fax:330-494-6630
Practice Address - Street 1:4774 MUNSON ST. NW
Practice Address - Street 2:SUITE 102
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-494-6653
Practice Address - Fax:330-494-6630
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0797955Medicaid
OH0797955Medicaid
OHCE0677323Medicare ID - Type Unspecified