Healthcare Provider Details

I. General information

NPI: 1366378192
Provider Name (Legal Business Name): THOMAS EDWARDS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 TERRACE ST
PITTSBURGH PA
15213-2523
US

IV. Provider business mailing address

6540 QUEENS WAY DR
COLUMBIA SC
29209-1531
US

V. Phone/Fax

Practice location:
  • Phone: 803-605-9888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11440
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: