Provider Demographics
NPI:1619064508
Name:BILLINGS, EDWARD W JR (DMD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:W
Last Name:BILLINGS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 S GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-2153
Mailing Address - Country:US
Mailing Address - Phone:334-335-3325
Mailing Address - Fax:334-335-3964
Practice Address - Street 1:79 S GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-2153
Practice Address - Country:US
Practice Address - Phone:334-335-3325
Practice Address - Fax:334-335-3964
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL90437OtherBCBS PROVIDER NUMBER