Healthcare Provider Details

I. General information

NPI: 1225007370
Provider Name (Legal Business Name): LEWIS TODD CARPENTER DDS, MS DIPL. ABP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 WOOD RD BLDG. 9 BLDG 9.
BETHESDA MD
20889
US

IV. Provider business mailing address

8955 WOOD RD BLDG 9
BETHESDA MD
20889-1119
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4361
  • Fax:
Mailing address:
  • Phone: 301-295-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2998
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: