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General NPI Number Information
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NPI Number | 1780445601
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Entity Type | Organization
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Legal Business Name | RAYMOND E CARPENTER D D S INC
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Dates
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Enumeration Date | 01/18/2024
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 4320 GENESEE AVE STE 207
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City | SAN DIEGO
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State | CA
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Zip | 92117-4900
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Country | US
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Telephone | 858-775-6361
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Fax |
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Provider Business Mailing Address
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Address Line | 4320 GENESEE AVE STE 207
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City | SAN DIEGO
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State | CA
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Zip | 92117-4900
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Country | US
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Telephone | 858-775-6361
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAYMOND E CARPENTER
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Credential | D D S
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Telephone | 858-775-6361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X2210X
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Taxonomy Name | Orofacial Pain Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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