Healthcare Provider Details

I. General information

NPI: 1881857142
Provider Name (Legal Business Name): CENTER FOR ORAL AND MAXILLOFACIAL SURGERY, JOE L. CARPENTER, DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6653 FRANK AVE NW
NORTH CANTON OH
44720-7259
US

IV. Provider business mailing address

6653 FRANK AVE NW
NORTH CANTON OH
44720-7259
US

V. Phone/Fax

Practice location:
  • Phone: 330-498-9920
  • Fax: 330-498-9921
Mailing address:
  • Phone: 330-498-9920
  • Fax: 330-498-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number17113
License Number StateOH

VIII. Authorized Official

Name: ROBERTA I POWELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-498-9920