Provider Demographics
NPI:1336268275
Name:CARPENTER, MICHELLE D (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:D
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 VENTURE DRIVE
Mailing Address - Street 2:STE C
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3436
Mailing Address - Country:US
Mailing Address - Phone:740-397-4097
Mailing Address - Fax:740-397-4142
Practice Address - Street 1:1684 VENTURE DRIVE
Practice Address - Street 2:STE C
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-397-4097
Practice Address - Fax:740-397-4142
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19709122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice