Healthcare Provider Details

I. General information

NPI: 1548483829
Provider Name (Legal Business Name): ABIGAIL C EDDS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE STE 103C
OWENSBORO KY
42303
US

IV. Provider business mailing address

2200 E PARRISH AVE STE 103C
OWENSBORO KY
42303-1450
US

V. Phone/Fax

Practice location:
  • Phone: 270-478-4788
  • Fax: 270-478-4811
Mailing address:
  • Phone: 270-478-4788
  • Fax: 270-478-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number8951
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010664
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: