Provider Demographics
NPI:1154952745
Name:EDMONDSON, TRINETTE (RDH)
Entity type:Individual
Prefix:
First Name:TRINETTE
Middle Name:
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:TN
Mailing Address - Zip Code:38363-2018
Mailing Address - Country:US
Mailing Address - Phone:731-847-6453
Mailing Address - Fax:
Practice Address - Street 1:213 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-2018
Practice Address - Country:US
Practice Address - Phone:731-847-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4446124Q00000X
TN4446124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist