MEDICARE: MARY KATHERINE 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	1223G0001X	General Practice Dentistry	11885	TN
2	1223G0001X	General Practice Dentistry	11908	NC

General Provider Information

NPI Number	:	1477015659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KATHERINE EDWARDS DDS

Provider Business Mailing Address
First Line	:	235 ST JOHN RD STE 110
Second Line	:
City	:	FLETCHER
State	:	NC
Zip	:	28732-8334
Country	:	US
Telephone Number	:	828-654-7450
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 ST JOHN RD STE 110
Second Line	:
City	:	FLETCHER
State	:	NC
Zip	:	28732-8334
Country	:	US
Telephone Number	:	828-654-7450
Fax Number	:

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

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	07/21/2022

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