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General NPI Number Information
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NPI Number | 1568839850
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Entity Type | Organization
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Legal Business Name | CARPENTER DENTAL CHARLES M. CARPENTER CHARLES M. CARPENTER JR. P.C.
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Dates
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Enumeration Date | 08/21/2015
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Last Update Date | 08/21/2015
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Provider Practice Location Address
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Address Line | 1086 WYOMING AVE
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City | FORTY FORT
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State | PA
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Zip | 18704-4014
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Country | US
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Telephone | 570-331-0909
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Fax | 570-714-5184
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Provider Business Mailing Address
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Address Line | 1086 WYOMING AVE
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City | FORTY FORT
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State | PA
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Zip | 18704-4014
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Country | US
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Telephone | 570-331-0909
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Fax | 570-714-5184
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES MARK CARPENTER
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Credential | D.M.D.
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Telephone | 570-331-0909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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