Individual provider Active NPI

Carl Cody Friddle, DDS

  • Dentist
  • Fort Smith, AR
National Provider Identifier
1336294180
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3558 Issued in AR
Practice address
5008 S U St
Sute 101a
Fort Smith, AR 72903-3613
Phone
(479) 452-8800
Fax
(479) 452-6926
NPI assigned
Jan 24, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 3558 AR Primary

Addresses

Primary practice location

5008 S U St
Sute 101a
Fort Smith, AR 72903-3613

Mailing address

5008 S U St
Sute 101a
Fort Smith, AR 72903-3613
Phone (479) 452-8800

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
3558ARMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Carl Cody Friddle DDS PLLC CurrentSince Jul 23, 2023 Accepting new patients
Carl R. Friddle, DDS, PA Dentist Past Accepting new patients

Locations

2121 Eisenhower Ave
Ste 502
Alexandria, VA 22314
Phone (479) 285-1589

Organizations & group practices 3

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": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336294180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5008 S U ST",
            "address_2": "SUTE 101A",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729033613",
            "telephone_number": "479-452-8800",
            "fax_number": "479-452-6926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5008 S U ST",
            "address_2": "SUTE 101A",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729033613",
            "telephone_number": "479-452-8800",
            "fax_number": "479-452-6926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRIDDLE",
        "first_name": "CARL",
        "middle_name": "CODY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "3558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.