Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 30-023825 | OH |
NPI | 1023339215 |
---|---|
Provider Name | Dr. Yissell Carpentino |
First Address | Bellbrook, OH 45305-1544 |
Second Address | Bellbrook, OH 45305-1544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 17/03/2018 |