Healthcare Provider Details

I. General information

NPI: 1730297276
Provider Name (Legal Business Name): KIMBERLY ROSSER CARR D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 14TH AVE S
BIRMINGHAM AL
35205-4931
US

IV. Provider business mailing address

PO BOX 59202
BIRMINGHAM AL
35259-9202
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-4912
  • Fax: 205-939-4915
Mailing address:
  • Phone: 205-939-4912
  • Fax: 205-939-4915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4666
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: