Provider Demographics
NPI:1548998388
Name:CARPENTER, KORY JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:KORY
Middle Name:JOSEPH
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SOUTH ASPEN ST, STOP 89
Mailing Address - Street 2:460 MDG
Mailing Address - City:BUCKLEY AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80011
Mailing Address - Country:US
Mailing Address - Phone:720-847-4118
Mailing Address - Fax:
Practice Address - Street 1:275 SOUTH ASPEN ST, STOP 89
Practice Address - Street 2:460 MDG
Practice Address - City:BUCKLEY AFB
Practice Address - State:CO
Practice Address - Zip Code:80011
Practice Address - Country:US
Practice Address - Phone:720-847-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00205196122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODEN.00205196OtherCOLORADO DENTAL BOARD