Individual
DR. BRENT R CARMONY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., D.D.S.
Contact information
Practice address
5305 COWHORN CREEK ROAD, TEXARKANA, TX 75503
(903) 791-8405
(903) 793-1046
Mailing address
5305 COWHORN CREEK ROAD, TEXARKANA, TX 75503
(903) 791-8405
(903) 793-1046
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
19239
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090180301
—
TX
05
—
090180302
—
TX
01
—
105690
ANTHEM BCBS VI
VI
05
—
135572679
—
AR
01
—
277330
UNITED CONCORDIA
AR
01
—
3109694
BCBS OF TN
TN
01
—
900-53697
BCBS OF AL
AL
01
—
97859
BLUE CROSS BLUE SHIELD AR
AR
01
—
D19239
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/05/2006
Last updated
02/11/2021
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