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General NPI Number Information
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NPI Number | 1588372080
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Entity Type | Organization
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Legal Business Name | HOMEGROWN PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 20808 HWY 71 SUITE C
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City | SPACEWOOD
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State | TX
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Zip | 78669
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Country | US
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Telephone | 805-490-3036
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Fax |
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Provider Business Mailing Address
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Address Line | 20808 HWY 71 SUITE C
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City | SPACEWOOD
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State | TX
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Zip | 78669
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. SARAH MARIE CARPENTER
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Credential | D.D.S.
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Telephone | 805-490-3036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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