Provider Demographics
NPI:1821104761
Name:MABRY, CARL DON (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:DON
Last Name:MABRY
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 1:600 TOWN CREEK RD. EAST
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772
Mailing Address - Country:US
Mailing Address - Phone:865-564-6001
Mailing Address - Fax:865-986-6459
Practice Address - Street 1:600 TOWN CREEK RD. EAST
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772
Practice Address - Country:US
Practice Address - Phone:865-564-6001
Practice Address - Fax:865-986-6459
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS44801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice