Provider Demographics
NPI:1114085024
Name:EDWARDS, M. GRACE MAPILI (DMD)
Entity Type:Individual
Prefix:DR
First Name:M. GRACE
Middle Name:MAPILI
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16115 SAINT VINCENT WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3001
Mailing Address - Country:US
Mailing Address - Phone:501-817-3157
Mailing Address - Fax:
Practice Address - Street 1:16115 SAINT VINCENT WAY STE 110
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-3001
Practice Address - Country:US
Practice Address - Phone:501-817-3157
Practice Address - Fax:501-817-3060
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3579OtherDELTA DENTAL INSURANCE