Provider Demographics
NPI:1275721672
Name:REBECCA R. EDWARDS,DDS,PA.
Entity Type:Organization
Organization Name:REBECCA R. EDWARDS,DDS,PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:R
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-886-3338
Mailing Address - Street 1:1045 W MAIN ST
Mailing Address - Street 2:SUITE A P.O. BOX 687
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476-1004
Mailing Address - Country:US
Mailing Address - Phone:870-886-3338
Mailing Address - Fax:870-886-6388
Practice Address - Street 1:1045 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476-1004
Practice Address - Country:US
Practice Address - Phone:870-886-3338
Practice Address - Fax:870-886-6388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty