Provider Demographics
NPI:1265474134
Name:PRICE, EDWARD DELANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DELANE
Last Name:PRICE
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:PO BOX 888
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-0888
Mailing Address - Country:US
Mailing Address - Phone:252-792-1131
Mailing Address - Fax:252-792-1132
Practice Address - Street 1:1888 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-8203
Practice Address - Country:US
Practice Address - Phone:252-792-1131
Practice Address - Fax:252-792-1132
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997093Medicaid
NC8997093Medicaid