Provider Demographics
NPI:1215076534
Name:CARPENTER, RAYMOND E (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:E
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4320 GENESEE AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4900
Mailing Address - Country:US
Mailing Address - Phone:858-277-3910
Mailing Address - Fax:858-277-3258
Practice Address - Street 1:4320 GENESEE AVE STE 207
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4900
Practice Address - Country:US
Practice Address - Phone:858-277-3910
Practice Address - Fax:858-277-3258
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258691223X2210X, 1223S0112X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223X2210XDental ProvidersDentistOrofacial Pain
No1223P0700XDental ProvidersDentistProsthodontics