Healthcare Provider Details

I. General information

NPI: 1598757981
Provider Name (Legal Business Name): GORDON WINDLEY EDWARDS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 S MASON RD
KATY TX
77450-4563
US

IV. Provider business mailing address

1620 S MASON RD
KATY TX
77450-4563
US

V. Phone/Fax

Practice location:
  • Phone: 281-693-0253
  • Fax: 281-693-0257
Mailing address:
  • Phone: 281-693-0253
  • Fax: 281-693-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11933
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: