Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | D7931 | AZ |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 037897 | NY |
NPI | 1033143458 |
---|---|
Provider Name | Dr. Robert Dennis Carpenter |
First Address | Goodyear, AZ 85395-2505 |
Second Address | Saratoga Springs, NY 12866-8624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 11/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01240248 | (05) | NY |
U11231 | (02) |