Individual
DR. BRENT R CARMONY
Active
Individual
DR. BRENT R CARMONY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., D.D.S.
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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