=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962579003
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA ANN EDWARDS DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 940 RICHARDS ROAD SUITE 103
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-333-6616
-----------------------------------------------------
Fax | 615-333-6577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 432 2ND AVENUE SOUTH
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37201-2319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-313-7640
-----------------------------------------------------
Fax | 615-313-7804
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS0000005081
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------