MEDICARE: CHAD M. 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	D05042525	SD

General Provider Information

NPI Number	:	1669675724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAD M. CARPENTER DDS

Provider Business Mailing Address
First Line	:	2525 W MAIN ST
Second Line	:	SUITE #307
City	:	RAPID CITY
State	:	SD
Zip	:	57702-0901
Country	:	US
Telephone Number	:	605-342-5995
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 W MAIN ST
Second Line	:	SUITE #307
City	:	RAPID CITY
State	:	SD
Zip	:	57702-0901
Country	:	US
Telephone Number	:	605-342-5995
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. CHAD M CARPENTER
Credential	:	DDS PC
Telephone Number	:	605-342-5995

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	08/22/2020

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