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General NPI Number Information
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NPI Number | 1720866452
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Entity Type | Organization
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Legal Business Name | FEDWARDS DENTAL PC
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Dates
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Enumeration Date | 09/14/2023
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 2781 AMBOY RD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2157
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Country | US
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Telephone | 718-273-1011
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Fax | 718-273-0308
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Provider Business Mailing Address
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Address Line | 2781 AMBOY RD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2157
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Country | US
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Telephone | 718-273-1101
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Fax | 718-273-0308
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Authorized Official
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Title or Position | OWNER /DDS
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Name | DR. WILLIAM F EDWARDS
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Credential | DDS
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Telephone | 718-273-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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