Healthcare Provider Details

I. General information

NPI: 1720019409
Provider Name (Legal Business Name): RICHARD CHARLES EDWARDS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 WESTFALL RD
ROCHESTER NY
14618-2611
US

IV. Provider business mailing address

880 WESTFALL RD
ROCHESTER NY
14618-2611
US

V. Phone/Fax

Practice location:
  • Phone: 585-473-1700
  • Fax: 585-271-0806
Mailing address:
  • Phone: 585-473-1700
  • Fax: 585-271-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number048032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: