Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 25869 | CA |
NPI | 1215076534 |
---|---|
Provider Name | Dr. Raymond E. Carpenter |
First Address | San Diego, CA 92117-4900 |
Second Address | San Diego, CA 92117-4900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 15/07/2021 |