Provider Demographics
NPI:1083760839
Name:EDWARDS, MORTON THOMAS JR (DMD, PA)
Entity Type:Individual
Prefix:DR
First Name:MORTON
Middle Name:THOMAS
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3628
Mailing Address - Country:US
Mailing Address - Phone:864-232-6911
Mailing Address - Fax:
Practice Address - Street 1:19 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3628
Practice Address - Country:US
Practice Address - Phone:864-232-6911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice