=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073293395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARL CODY FRIDDLE DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2023
-----------------------------------------------------
Last Update Date | 07/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 EISENHOWER AVE STE 502
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22314-4688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-285-1589
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6911 FORT HUNT RD
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22307-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-285-1589
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. CARL CODY FRIDDLE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 479-285-1598
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------