Provider Demographics
NPI:1336294180
Name:FRIDDLE, CARL CODY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:CODY
Last Name:FRIDDLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 S U ST
Mailing Address - Street 2:SUTE 101A
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3613
Mailing Address - Country:US
Mailing Address - Phone:479-452-8800
Mailing Address - Fax:479-452-6926
Practice Address - Street 1:5008 S U ST
Practice Address - Street 2:SUTE 101A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3613
Practice Address - Country:US
Practice Address - Phone:479-452-8800
Practice Address - Fax:479-452-6926
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist