Provider Demographics
NPI:1376729095
Name:CARL CODY FRIDDLE, PLLC
Entity Type:Organization
Organization Name:CARL CODY FRIDDLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:479-452-8800
Mailing Address - Street 1:5008 S U ST
Mailing Address - Street 2:
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty