MEDICARE: DR. GORDON WINDLEY EDWARDS 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	11933	TX

General Provider Information

NPI Number	:	1598757981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GORDON WINDLEY EDWARDS DDS

Provider Business Mailing Address
First Line	:	1620 S MASON RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-4563
Country	:	US
Telephone Number	:	281-693-0253
Fax Number	:	281-693-0257

Provider Business Practice Location Address
First Line	:	1620 S MASON RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-4563
Country	:	US
Telephone Number	:	281-693-0253
Fax Number	:	281-693-0257

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	02/10/2015

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