Provider Demographics
NPI:1497999841
Name:FRANKLIN, EDMOND MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:MICHAEL
Last Name:FRANKLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 WICKUM RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1298
Mailing Address - Country:US
Mailing Address - Phone:404-202-2398
Mailing Address - Fax:
Practice Address - Street 1:1177 GARDEN WALK BLVD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-6245
Practice Address - Country:US
Practice Address - Phone:770-997-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14425122300000X
GADNO13853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist