MEDICARE: DR. GREGORY 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	2741	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2741	OTHER	NV	DENTAL LICENSE

General Provider Information

NPI Number	:	1598781536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY EDWARDS DDS

Provider Business Mailing Address
First Line	:	4125 ERINBIRD AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-4807
Country	:	US
Telephone Number	:	702-396-5746
Fax Number	:	702-307-1903

Provider Business Practice Location Address
First Line	:	1811 S RAINBOW BLVD
Second Line	:	STE 208
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0894
Country	:	US
Telephone Number	:	702-433-2489
Fax Number	:	702-434-2483

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	05/01/2008

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