Individual
DR. CAROLE FULLER-EDMONDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
201 N MAIN ST, SUITE J, BOAZ, AL 35957-1601
(256) 593-0035
(256) 593-9101
Mailing address
PO BOX 309, PISGAH, AL 35765-0309
(256) 593-0035
(256) 593-9101
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
4276
AL
1223G0001X
General Practice Dentistry
Primary
4276 AL
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009006500
—
AL
01
—
135433
BCBS-DENTAL
TN
01
—
51090809
BCBS - DENTAL
AL
01
—
630980899
DELTA USA
AL
01
—
887635
UNITED CONCORDOA - DENTAL
AL
Enumeration date
02/27/2006
Last updated
06/27/2023
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