MEDICARE: DR. DAVE S. CARPENTER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	13727	TX

General Provider Information

NPI Number	:	1629071915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVE S. CARPENTER DDS

Provider Business Mailing Address
First Line	:	3560 DELAWARE STE.
Second Line	:	SUITE 1003
City	:	BEAUMONT
State	:	TX
Zip	:	77706
Country	:	US
Telephone Number	:	409-898-4300
Fax Number	:	409-898-2777

Provider Business Practice Location Address
First Line	:	3560 DELAWARE ST
Second Line	:	STE 1003
City	:	BEAUMONT
State	:	TX
Zip	:	77706-3026
Country	:	US
Telephone Number	:	409-898-4300
Fax Number	:	409-898-2777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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