Provider Demographics
NPI:1548483829
Name:EDDS, ABIGAIL C (DMD)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:C
Last Name:EDDS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E PARRISH AVE STE 103C
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1450
Mailing Address - Country:US
Mailing Address - Phone:270-478-4788
Mailing Address - Fax:270-478-4811
Practice Address - Street 1:2200 E PARRISH AVE STE 103C
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-478-4788
Practice Address - Fax:270-478-4811
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120106641223G0001X
KY89511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice