Healthcare Provider Details

I. General information

NPI: 1114974276
Provider Name (Legal Business Name): CARL ARTHUR HUMPHRIES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 12TH AVE NE
ARAB AL
35016-5403
US

IV. Provider business mailing address

PO BOX 586
ARAB AL
35016-0586
US

V. Phone/Fax

Practice location:
  • Phone: 256-586-1330
  • Fax: 256-586-1329
Mailing address:
  • Phone: 256-586-1330
  • Fax: 256-586-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3859
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: