1598781536 NPI number — DR. GREGORY EDWARDS DDS

Table of content: DR. GREGORY EDWARDS DDS (NPI 1598781536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598781536 NPI number — DR. GREGORY EDWARDS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
GREGORY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598781536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1811 S RAINBOW BLVD
Provider Second Line Business Practice Location Address:
STE 208
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146-0894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-433-2489
Provider Business Practice Location Address Fax Number:
702-434-2483
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2741 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2741 . This is a "DENTAL LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com