Healthcare Provider Details

I. General information

NPI: 1619064508
Provider Name (Legal Business Name): EDWARD W BILLINGS JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 S GLENWOOD AVE
LUVERNE AL
36049-2153
US

IV. Provider business mailing address

79 S GLENWOOD AVE
LUVERNE AL
36049-2153
US

V. Phone/Fax

Practice location:
  • Phone: 334-335-3325
  • Fax: 334-335-3964
Mailing address:
  • Phone: 334-335-3325
  • Fax: 334-335-3964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4996
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: