MEDICARE: MATTHEW BRITTON EDWARDS CDT

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	126900000X	Dental Laboratory Technician	041586E01628	VA

General Provider Information

NPI Number	:	1578614905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW BRITTON EDWARDS CDT

Provider Business Mailing Address
First Line	:	1237 RIVER OAKS DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-2041
Country	:	US
Telephone Number	:	757-362-4611
Fax Number	:	757-853-6966

Provider Business Practice Location Address
First Line	:	1237 RIVER OAKS DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-2041
Country	:	US
Telephone Number	:	757-362-4611
Fax Number	:	757-853-6966

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

Provider Enumeration Date	:	01/14/2007
Last Update Date	:	07/08/2007

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