Provider Demographics
NPI:1134298441
Name:EDWARDS, REBECCA R (DDS)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:R
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 1:1605 UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655
Mailing Address - Country:US
Mailing Address - Phone:662-380-5700
Mailing Address - Fax:662-380-5704
Practice Address - Street 1:1605 UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-380-5700
Practice Address - Fax:662-380-5704
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3670-12122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04574243Medicaid
AR129498608Medicaid