Provider Demographics
NPI:1790842003
Name:ALLDREDGE, CARLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:ALLDREDGE
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 1:4727 ROSEBUD LN STE A
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9225
Mailing Address - Country:US
Mailing Address - Phone:812-490-9500
Mailing Address - Fax:812-490-9595
Practice Address - Street 1:4727 ROSEBUD LN STE A
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9225
Practice Address - Country:US
Practice Address - Phone:812-490-9500
Practice Address - Fax:812-490-9595
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19026963122300000X
IN12010928A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist