Healthcare Provider Details

I. General information

NPI: 1841358793
Provider Name (Legal Business Name): MADELYN COAR DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 7TH AVE S SDB BOX 58
BIRMINGHAM AL
35294-0007
US

IV. Provider business mailing address

1919 7TH AVE S SDB BOX 58 1
BIRMINGHAM AL
35294
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-2340
  • Fax: 205-934-7899
Mailing address:
  • Phone: 205-934-2340
  • Fax: 205-934-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3574
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: