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General NPI Number Information
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NPI Number | 1326474370
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Entity Type | Organization
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Legal Business Name | ESTEY AND CARPENTER DENTAL CORPORATION
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Dates
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Enumeration Date | 09/23/2013
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 1806 ORANGE TREE LN SUITE B
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City | REDLANDS
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State | CA
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Zip | 92374-4569
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Country | US
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Telephone | 909-335-1166
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Fax | 909-335-1166
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Provider Business Mailing Address
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Address Line | 1806 ORANGE TREE LN SUITE B
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City | REDLANDS
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State | CA
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Zip | 92374-4569
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Country | US
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Telephone | 909-335-1166
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Fax | 909-335-1166
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Authorized Official
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Title or Position | CORPORATE PRESIDENT
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Name | DR. MARK JAMES CARPENTER
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Credential | DDS
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Telephone | 909-335-1166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 45253
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 28847
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 45230
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License Number State | CA
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