Healthcare Provider Details

I. General information

NPI: 1376893271
Provider Name (Legal Business Name): MICHAEL D. EDWARDS, D.M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 MAIN STREET NORTH
WEDOWEE AL
36278-0370
US

IV. Provider business mailing address

PO BOX 370
WEDOWEE AL
36278-0370
US

V. Phone/Fax

Practice location:
  • Phone: 256-357-2882
  • Fax: 256-257-2883
Mailing address:
  • Phone: 256-357-2882
  • Fax: 256-357-2883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL D. EDWARDS
Title or Position: PRESIDENT
Credential:
Phone: 256-357-2882