Healthcare Provider Details

I. General information

NPI: 1720159809
Provider Name (Legal Business Name): MAURICE LUTHER EDWARDS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 12/11/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 EAST 60TH STREET 1401
NEW YORK NY
10022
US

IV. Provider business mailing address

30 EAST 60TH STREET SUITE 1401
NEW YORK NY
10022
US

V. Phone/Fax

Practice location:
  • Phone: 212-888-8624
  • Fax: 212-838-5533
Mailing address:
  • Phone: 212-888-8624
  • Fax: 212-755-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number046335
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: