Provider Demographics
NPI:1114926656
Name:EPIFANI, EDWARD LOUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LOUIS
Last Name:EPIFANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1296 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4200
Mailing Address - Country:US
Mailing Address - Phone:503-585-4282
Mailing Address - Fax:503-375-9534
Practice Address - Street 1:1296 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 101
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4204
Practice Address - Country:US
Practice Address - Phone:503-585-4282
Practice Address - Fax:503-375-9534
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist