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General NPI Number Information
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NPI Number | 1063864965
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Entity Type | Individual
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Provider Name | ANDREW EDMONDS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 4405 WILLIAMS DR STE 300
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City | GEORGETOWN
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State | TX
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Zip | 78628-1383
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Country | US
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Telephone | 512-855-7308
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Fax |
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Provider Business Mailing Address
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Address Line | 4405 WILLIAMS DR STE 300
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City | GEORGETOWN
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State | TX
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Zip | 78628-1383
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 31946
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License Number State | TX
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