MEDICARE: DR. EDWARD C. SENIOR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7911	NC

General Provider Information

NPI Number	:	1548358088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD C. SENIOR DDS

Provider Business Mailing Address
First Line	:	3053B FREEDOM DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3859
Country	:	US
Telephone Number	:	704-393-3911
Fax Number	:

Provider Business Practice Location Address
First Line	:	3053B FREEDOM DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3859
Country	:	US
Telephone Number	:	704-393-3911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	05/20/2013

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