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General NPI Number Information
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NPI Number | 1417186149
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Entity Type | Organization
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Legal Business Name | JOEL T. EDWARDS, DDS PLLC
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 1508 N GRANDVIEW AVE SUITE 5
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City | ODESSA
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State | TX
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Zip | 79761-3000
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Country | US
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Telephone | 432-272-1190
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Fax | 800-532-0728
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Provider Business Mailing Address
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Address Line | 1508 N GRANDVIEW AVE SUITE 5
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City | ODESSA
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State | TX
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Zip | 79761-3000
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Country | US
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Telephone | 432-272-1190
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Fax | 800-532-0728
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JOEL EDWARDS
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Credential | DDS
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Telephone | 432-272-1190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 21784
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License Number State | TX
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