Individual
DR. GARY MARTIN EDGMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
7003 SHALLOWFORD RD STE 201, CHATTANOOGA, TN 37421
(423) 541-1850
Mailing address
7003 SHALLOWFORD RD STE 201, CHATTANOOGA, TN 37421-6722
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
09156
GA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
10198
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376027862
—
TN
05
—
Q045942
—
TN
05
—
Q046284
—
TN
Enumeration date
11/15/2006
Last updated
03/20/2019
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