MEDICARE: C'VAEO 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	122300000X	Dentist	2901602327	MI

General Provider Information

NPI Number	:	1881419554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	C'VAEO EDWARDS DDS

Provider Business Mailing Address
First Line	:	16800 W 12 MILE RD STE 103
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-6335
Country	:	US
Telephone Number	:	248-443-5371
Fax Number	:

Provider Business Practice Location Address
First Line	:	16800 W 12 MILE RD STE 103
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-6335
Country	:	US
Telephone Number	:	248-443-5371
Fax Number	:

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

Provider Enumeration Date	:	11/18/2024
Last Update Date	:	11/18/2024

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