Healthcare Provider Details

I. General information

NPI: 1194745570
Provider Name (Legal Business Name): DAVID M. EDWARDS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 WINDLASS CIR
ANCHORAGE AK
99516-3438
US

IV. Provider business mailing address

3330 WINDLASS CIR
ANCHORAGE AK
99516-3438
US

V. Phone/Fax

Practice location:
  • Phone: 907-345-7148
  • Fax:
Mailing address:
  • Phone: 907-345-7148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number533
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: