Provider Demographics
NPI:1558476143
Name:FELLOWS, EDWARD ARNOLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ARNOLD
Last Name:FELLOWS
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 1:12 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2806
Mailing Address - Country:US
Mailing Address - Phone:954-966-0072
Mailing Address - Fax:954-966-7334
Practice Address - Street 1:5100 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6538
Practice Address - Country:US
Practice Address - Phone:954-454-9200
Practice Address - Fax:954-966-7334
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 76901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice