Provider Demographics
NPI:1407802457
Name:TOMBRELLO, CARRIE F (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:F
Last Name:TOMBRELLO
Suffix:
Gender:F
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 769
Mailing Address - Street 2:
Mailing Address - City:BAYOU LA BATRE
Mailing Address - State:AL
Mailing Address - Zip Code:36509-0769
Mailing Address - Country:US
Mailing Address - Phone:251-824-2347
Mailing Address - Fax:251-824-4337
Practice Address - Street 1:13040 N WINTZELL AVE
Practice Address - Street 2:
Practice Address - City:BAYOU LA BATRE
Practice Address - State:AL
Practice Address - Zip Code:36509-2110
Practice Address - Country:US
Practice Address - Phone:251-824-2347
Practice Address - Fax:251-824-4337
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLNO 5351122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL23492Medicare ID - Type Unspecified