Healthcare Provider Details

I. General information

NPI: 1811031040
Provider Name (Legal Business Name): MICHELLE HALUM EDWARDS DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9865 E 116TH ST 100
FISHERS IN
46037-9231
US

IV. Provider business mailing address

6490 TIMBER WALK DR
INDIANAPOLIS IN
46236-7725
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-8453
  • Fax: 317-842-8741
Mailing address:
  • Phone: 317-826-8663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12010350A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: