Provider Demographics
NPI:1609967330
Name:PUMPHREY, CARRIE ELLEN (DDS)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELLEN
Last Name:PUMPHREY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 N RILEY HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-9171
Mailing Address - Country:US
Mailing Address - Phone:317-392-1468
Mailing Address - Fax:
Practice Address - Street 1:1818 N RILEY HWY
Practice Address - Street 2:SUITE A
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-9171
Practice Address - Country:US
Practice Address - Phone:317-392-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332B00000X
IN120103711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies