=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225007370
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEWIS TODD CARPENTER DDS, MS DIPL. ABP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2006
-----------------------------------------------------
Last Update Date | 01/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8955 WOOD RD BLDG. 9 BLDG 9.
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20889
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-295-4361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8955 WOOD RD BLDG 9
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20889-1119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-295-4361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | 2998
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------