Individual
BRADLEY WAYNE CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
15480 SE 82ND DR, CLACAMAS, OR 97015
(503) 655-7250
(503) 650-6375
Mailing address
PO BOX 446, CLACKAMAS, OR 97015-0446
(503) 655-7250
(503) 650-6375
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5494
OR
Other
Enumeration date
03/06/2012
Last updated
03/06/2012
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