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General NPI Number Information
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NPI Number | 1881857142
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Entity Type | Organization
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Legal Business Name | CENTER FOR ORAL AND MAXILLOFACIAL SURGERY, JOE L. CARPENTER, DMD, INC.
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 6653 FRANK AVE NW
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City | NORTH CANTON
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State | OH
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Zip | 44720-7259
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Country | US
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Telephone | 330-498-9920
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Fax | 330-498-9921
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Provider Business Mailing Address
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Address Line | 6653 FRANK AVE NW
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City | NORTH CANTON
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State | OH
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Zip | 44720-7259
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Country | US
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Telephone | 330-498-9920
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Fax | 330-498-9921
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ROBERTA I POWELL
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Credential |
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Telephone | 330-498-9920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 17113
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License Number State | OH
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