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General NPI Number Information
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NPI Number | 1992157416
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Entity Type | Individual
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Provider Name | ROLAND EDWARDS III
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Gender | Male
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Dates
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Enumeration Date | 07/08/2016
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Last Update Date | 07/08/2016
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Provider Practice Location Address
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Address Line | 161 EAST AVE SUITE 11
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City | NORWALK
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State | CT
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Zip | 06851-5710
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Country | US
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Telephone | 203-299-1601
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Fax |
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Provider Business Mailing Address
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Address Line | 161 EAST AVE SUITE 11
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City | NORWALK
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State | CT
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Zip | 06851-5710
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Country | US
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Telephone | 203-299-1601
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Fax |
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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 | 126900000X
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Taxonomy Name | Dental Laboratory Technician
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License Number |
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License Number State |
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