Provider Demographics
NPI:1063040913
Name:EDWARDS, LETITIA MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:LETITIA
Middle Name:MARIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 BRUSHY PEAK CT
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-6939
Mailing Address - Country:US
Mailing Address - Phone:925-998-1166
Mailing Address - Fax:
Practice Address - Street 1:5531 BRUSHY PEAK CT
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-6939
Practice Address - Country:US
Practice Address - Phone:925-998-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1060381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry