Provider Demographics
NPI:1790309169
Name:MADDOX, CAROLINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:MADDOX
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CAROLINE
Other - Middle Name:MADDOX
Other - Last Name:SPRUIELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:513 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5301
Mailing Address - Country:US
Mailing Address - Phone:256-543-7444
Mailing Address - Fax:
Practice Address - Street 1:513 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5301
Practice Address - Country:US
Practice Address - Phone:256-543-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.0006746-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist