Provider Demographics
NPI:1073293395
Name:CARL CODY FRIDDLE DDS PLLC
Entity Type:Organization
Organization Name:CARL CODY FRIDDLE DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:CODY
Authorized Official - Last Name:FRIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-285-1598
Mailing Address - Street 1:6911 FORT HUNT RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-1717
Mailing Address - Country:US
Mailing Address - Phone:479-285-1589
Mailing Address - Fax:
Practice Address - Street 1:2121 EISENHOWER AVE STE 502
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4688
Practice Address - Country:US
Practice Address - Phone:479-285-1589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental