MEDICARE: DR. THOMAS WALTER EDWARDS JR. 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	1223G0001X	General Practice Dentistry	D20517	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D20517	OTHER	CA	DENTIST

General Provider Information

NPI Number	:	1770503427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS WALTER EDWARDS JR. D.D.S.

Provider Business Mailing Address
First Line	:	10921 WILSHIRE BLVD STE 1010
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4003
Country	:	US
Telephone Number	:	310-208-8661
Fax Number	:	310-476-7215

Provider Business Practice Location Address
First Line	:	10921 WILSHIRE BLVD STE 1010
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4003
Country	:	US
Telephone Number	:	310-208-8661
Fax Number	:	310-476-7215

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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