MEDICARE: MARY M EDWARDS DDS

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	122300000X	Dentist	6171	CO

General Provider Information

NPI Number	:	1205155686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY M EDWARDS DDS

Provider Business Mailing Address
First Line	:	1242 N CLEVELAND AVE
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-4725
Country	:	US
Telephone Number	:	970-667-6101
Fax Number	:	970-663-2766

Provider Business Practice Location Address
First Line	:	1242 N CLEVELAND AVE
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-4725
Country	:	US
Telephone Number	:	970-667-6101
Fax Number	:	970-663-2766

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

Provider Enumeration Date	:	05/24/2010
Last Update Date	:	03/08/2026

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