MEDICARE: DR. CARL RAY FRIDDLE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2206	AR

General Provider Information

NPI Number	:	1467507210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL RAY FRIDDLE DDS

Provider Business Mailing Address
First Line	:	5008 S U ST
Second Line	:	SUITE 101A
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3613
Country	:	US
Telephone Number	:	479-452-8800
Fax Number	:	479-452-6926

Provider Business Practice Location Address
First Line	:	5008 S U ST
Second Line	:	SUITE 101A
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3613
Country	:	US
Telephone Number	:	479-452-8800
Fax Number	:	479-452-6926

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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