=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578699963
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE ELIZABETH EDWARDS DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 163 S RIVER STREET
-----------------------------------------------------
City | PLAINS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-822-3040
-----------------------------------------------------
Fax | 570-821-4529
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 163 S RIVER STREET
-----------------------------------------------------
City | PLAINS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-822-3040
-----------------------------------------------------
Fax | 570-821-4529
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS027807L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------