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General NPI Number Information
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NPI Number | 1528102183
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Entity Type | Individual
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Provider Name | R DOUGLAS EDWARDS JR. DMD
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Gender | Male
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 3807 FREEDOM WAY
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City | LOUISVILLE
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State | KY
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Zip | 40229
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Country | US
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Telephone | 502-969-3205
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Fax | 520-969-8306
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Provider Business Mailing Address
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Address Line | 3807 FREEDOM WAY
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City | LOUISVILLE
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State | KY
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Zip | 40229
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Country | US
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Telephone | 502-969-3205
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Fax | 520-969-8306
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4050
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4050
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License Number State | KY
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