Provider Demographics
NPI:1699179457
Name:RICHARD M. BEDSOLE, D.M.D., P.C.
Entity Type:Organization
Organization Name:RICHARD M. BEDSOLE, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-355-7168
Mailing Address - Street 1:1316 STRATFORD RD SE
Mailing Address - Street 2:BUILDING 1 SUITE 1
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6036
Mailing Address - Country:US
Mailing Address - Phone:256-355-1687
Mailing Address - Fax:256-351-1322
Practice Address - Street 1:1316 STRATFORD RD SE
Practice Address - Street 2:BUILDING 1 SUITE 1
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6036
Practice Address - Country:US
Practice Address - Phone:256-355-1687
Practice Address - Fax:256-351-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty