Provider Demographics
NPI:1053523464
Name:EDWARDS, WILLIAM R (DMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:EDWARDS
Suffix:
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 1:15 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1250
Mailing Address - Country:US
Mailing Address - Phone:570-748-3595
Mailing Address - Fax:570-748-9622
Practice Address - Street 1:15 W WATER ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1250
Practice Address - Country:US
Practice Address - Phone:570-748-3595
Practice Address - Fax:570-748-9622
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016149L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA62341OtherUCCI PROVIDER NUMBER