Provider Demographics
NPI:1114974276
Name:HUMPHRIES, CARL ARTHUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:ARTHUR
Last Name:HUMPHRIES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:ARAB
Mailing Address - State:AL
Mailing Address - Zip Code:35016-0586
Mailing Address - Country:US
Mailing Address - Phone:256-586-1330
Mailing Address - Fax:256-586-1329
Practice Address - Street 1:15 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:ARAB
Practice Address - State:AL
Practice Address - Zip Code:35016-5403
Practice Address - Country:US
Practice Address - Phone:256-586-1330
Practice Address - Fax:256-586-1329
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009998930Medicaid
AL510-93552OtherBC/BS OF AL PROVIDER NO.
AL4348602OtherAETNA PROVIDER NO.
AL0121721OtherBC/BS OF TN PROVIDER NO.
ALAL3859OtherMUTUAL OF OMAHA
AL7102000000ALOtherBC/BS OF MI PROVIDER NO
AL848340OtherUNITED CONCORDIA PROVIDER