Provider Demographics
NPI:1902964976
Name:CARPENTER, ROBERT HENLEY JR (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HENLEY
Last Name:CARPENTER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8030
Mailing Address - Country:US
Mailing Address - Phone:706-660-9848
Mailing Address - Fax:706-660-9855
Practice Address - Street 1:1901 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8030
Practice Address - Country:US
Practice Address - Phone:706-660-9848
Practice Address - Fax:706-660-9855
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0107641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice