Provider Demographics
NPI:1922120757
Name:DRUMMOND, CHARLES O (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:O
Last Name:DRUMMOND
Suffix:
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 1:3825 LORNA RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3003
Mailing Address - Country:US
Mailing Address - Phone:205-988-0363
Mailing Address - Fax:205-988-0399
Practice Address - Street 1:3825 LORNA RD STE 210
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3003
Practice Address - Country:US
Practice Address - Phone:205-988-0363
Practice Address - Fax:205-988-0399
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4225122300000X
FL11581122300000X
NC5871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL91466OtherBCBS OF ALA ID
AL985185OtherUNITED CONCORDIA