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General NPI Number Information
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NPI Number | 1538578919
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Entity Type | Organization
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Legal Business Name | COURTNEY P EDWARDS
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 10/31/2014
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Provider Practice Location Address
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Address Line | 2303 W MOREHEAD ST SUITE 103
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City | CHARLOTTE
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State | NC
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Zip | 28208-5186
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Country | US
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Telephone | 704-817-8728
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Fax | 704-817-7538
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Provider Business Mailing Address
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Address Line | 2303 W MOREHEAD ST SUITE 103
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City | CHARLOTTE
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State | NC
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Zip | 28208-5186
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Country | US
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Telephone | 704-817-8727
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Fax | 704-817-7538
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Authorized Official
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Title or Position | DENTIST
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Name | DR. COURTNEY PATRICE EDWARDS
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Credential | DDS
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Telephone | 704-817-8728
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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 | 8943
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License Number State | NC
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