MEDICARE: DR. MORTON THOMAS EDWARDS JR. D.M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2489	SC

General Provider Information

NPI Number	:	1083760839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MORTON THOMAS EDWARDS JR. D.M.D., P.A.

Provider Business Mailing Address
First Line	:	19 CLEVELAND ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-3628
Country	:	US
Telephone Number	:	864-232-6911
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 CLEVELAND ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-3628
Country	:	US
Telephone Number	:	864-232-6911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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