NPIMap

Individual provider Active NPI

Carson Myles Cruise, DMD

  • Pediatric Dentistry
  • Florence, AL
National Provider Identifier
1104208651
Registry record updated Jul 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D.0006743-C1 Issued in AL
Practice address
162 Ana Dr
Florence, AL 35630-1759
Phone
(256) 766-0270
Fax
(256) 766-8328
NPI assigned
Jun 22, 2015
Last updated
Jul 28, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 3799-15 MS
Pediatric Dentistry 1223P0221X 6838 LA
Pediatric Dentistry 1223P0221X 0442000266 VA
Pediatric Dentistry 1223P0221X D.0006743-C1 AL Primary

Addresses

Primary practice location

162 Ana Dr
Florence, AL 35630-1759

Mailing address

162 Ana Dr
Florence, AL 35630-1759
Phone (256) 766-0270

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6838LAMDCounselor
3799-15MSMDDentist
D.0006743-C1ALMDPediatric Dentist
0442000266VAMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
The Pediatric Dental Clinic Pediatric Dentistry CurrentSince Aug 2, 2020 Accepting new patients
DRS Michael Gambill and Corey Cloud LLC Pediatric Dentistry PastSince Dec 1, 2023 Accepting new patients
Dr. Michael Gambill and Dr. David Glass LLC Pediatric Dentistry Past Accepting new patients
Pediatric Dental Clinic Pediatric Dentistry PastSince Aug 2, 2020 Accepting new patients

Locations

162 Ana Dr
Florence, AL 35630
Phone (256) 766-0270

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595894400000",
    "number": "1104208651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 ANA DR",
            "city": "FLORENCE",
            "state": "AL",
            "postal_code": "356301759",
            "telephone_number": "256-766-0270",
            "fax_number": "256-766-8328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 ANA DR",
            "city": "FLORENCE",
            "state": "AL",
            "postal_code": "356301759",
            "telephone_number": "256-766-0270",
            "fax_number": "256-766-8328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUISE",
        "first_name": "CARSON",
        "middle_name": "MYLES",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-22",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3799-15",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "LA",
            "license": "6838",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0442000266",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AL",
            "license": "D.0006743-C1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.