Provider Demographics
NPI:1215043344
Name:EDWARDS, TERYL DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERYL
Middle Name:DALE
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701
Mailing Address - Country:US
Mailing Address - Phone:319-232-4505
Mailing Address - Fax:
Practice Address - Street 1:220 W RIDGEWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701
Practice Address - Country:US
Practice Address - Phone:319-232-9023
Practice Address - Fax:319-232-1610
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA64531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0101OtherJOHN DEERE
IA0163089Medicaid
16549OtherBCBS
AL10519OtherBCBS OF AL
506900OtherUCCI
KS311848Other311848