MEDICARE: CHRISTIAN EDWARDS

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	DGD.10283	SC

General Provider Information

NPI Number	:	1366175390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN EDWARDS

Provider Business Mailing Address
First Line	:	2138 HIGHWAY 41
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-6201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2138 HIGHWAY 41
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-6201
Country	:	US
Telephone Number	:	843-972-5587
Fax Number	:

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

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	07/07/2022

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Directions to “ CHRISTIAN EDWARDS ” Practice Location

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