Provider Demographics
NPI:1053355933
Name:KAISER, EDWARD MARK JR (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MARK
Last Name:KAISER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BUTE RD
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-5544
Mailing Address - Country:US
Mailing Address - Phone:724-438-9100
Mailing Address - Fax:724-430-0805
Practice Address - Street 1:102 BUTE RD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-5544
Practice Address - Country:US
Practice Address - Phone:724-438-9100
Practice Address - Fax:724-430-0805
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0363381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101490339Medicaid