Healthcare Provider Details

I. General information

NPI: 1215028535
Provider Name (Legal Business Name): WILLIAM FELIX EDWARDS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2781 AMBOY RD
STATEN ISLAND NY
10306-2157
US

IV. Provider business mailing address

2781 AMBOY RD
STATEN ISLAND NY
10306-2157
US

V. Phone/Fax

Practice location:
  • Phone: 718-273-1101
  • Fax: 718-273-0308
Mailing address:
  • Phone: 718-273-1101
  • Fax: 718-273-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI01934400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number0455421
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: