Provider Demographics
NPI:1275674012
Name:AGEE, LINDA BURKS (DMD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:BURKS
Last Name:AGEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NOTASULGA ROAD
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-7115
Mailing Address - Country:US
Mailing Address - Phone:334-727-7211
Mailing Address - Fax:
Practice Address - Street 1:1201 NOTASULGA ROAD
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-7115
Practice Address - Country:US
Practice Address - Phone:334-727-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL149318Medicaid
AL511-36354OtherBLUE CROSS
AL90110OtherAMERITUS
AL90110OtherBNLAC
AL90110OtherUNITED HEALTH
AL90110OtherDELTA
AL90110OtherCIGNA
AL90110OtherAFLAC
AL90110OtherSOUTHLAND
90110OtherBCBS
AL90110OtherMAILHANDLERS
AL631000006Medicaid