Provider Demographics
NPI:1588372080
Name:HOMEGROWN PEDIATRIC DENTISTRY, PLLC
Entity type:Organization
Organization Name:HOMEGROWN PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-490-3036
Mailing Address - Street 1:20808 HWY 71
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPACEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20808 HWY 71
Practice Address - Street 2:SUITE C
Practice Address - City:SPACEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669
Practice Address - Country:US
Practice Address - Phone:805-490-3036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty