Healthcare Provider Details

I. General information

NPI: 1720866452
Provider Name (Legal Business Name): FEDWARDS DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2023
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: 718-273-1011
  • 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 Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM F EDWARDS
Title or Position: OWNER /DDS
Credential: DDS
Phone: 718-273-1101