Provider Demographics
NPI:1154783280
Name:CAROLE FULLER EDMONDS, DMD
Entity type:Organization
Organization Name:CAROLE FULLER EDMONDS, DMD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-593-0035
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:PISGAH
Mailing Address - State:AL
Mailing Address - Zip Code:35765-0309
Mailing Address - Country:US
Mailing Address - Phone:256-593-0035
Mailing Address - Fax:256-593-9101
Practice Address - Street 1:201 N MAIN ST STE J
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-1643
Practice Address - Country:US
Practice Address - Phone:256-593-0035
Practice Address - Fax:256-593-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5809122300000X
AL4276122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1144296302OtherNPPES
AL1194028431OtherNPPES