Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Carl Ross Provenzano, DDS

Individual provider General Practice Dentistry · NPI 1548895543

Carl Ross Provenzano, DDS is a General Practice Dentistry in Birmingham, Alabama. Licensed in Alabama, Oregon, Pennsylvania and Tennessee and 1 more. Registered with an NPI since 2020.

Licensed in
AL, OR, PA, TN, TX
In the registry since
2020
Specialties on file
7
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

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Practice location Address checks out

625 19th St S
Birmingham, AL 35233-1900
Phone: (205) 934-4507
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence D-6826-C1 (AL)
General Practice Dentistry Taxonomy 1223G0001X · Licence 41386 (TX)
General Practice Dentistry Taxonomy 1223G0001X · Licence D12166 (OR)
General Practice Dentistry Taxonomy 1223G0001X · Licence DS045261 (PA)
General Practice Dentistry Taxonomy 1223G0001X · Licence 12799 (TN)
Oral and Maxillofacial Surgery (Dentist) Taxonomy 1223S0112X · Licence D-6826-C1 (AL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1548895543
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorNo
NPI enumeratedMarch 10, 2020
Last updated in NPPESAugust 25, 2025
Certification dateAugust 25, 2025

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