MEDICARE: DR. BENJAMIN FRANKLIN EDWARDS III D.D.S.

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	6279	OK

General Provider Information

NPI Number	:	1750677159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN FRANKLIN EDWARDS III D.D.S.

Provider Business Mailing Address
First Line	:	1801 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2814
Country	:	US
Telephone Number	:	580-332-1660
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2814
Country	:	US
Telephone Number	:	580-332-1660
Fax Number	:

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

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	06/23/2011

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