Healthcare Provider Details

I. General information

NPI: 1881833770
Provider Name (Legal Business Name): THOMAS LEWIS EDLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W ST NW DEPARTMENT OF RESTORATIVE SERVICES
WASHINGTON DC
20059-0001
US

IV. Provider business mailing address

600 W ST NW DEPARTMENT OF RESTORATIVE SERVICES
WASHINGTON DC
20059-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-806-0389
  • Fax:
Mailing address:
  • Phone: 202-806-0389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN4725
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: