Provider Demographics
NPI:1346887635
Name:KRISTIN C EDWARDS DDS PLLC
Entity Type:Organization
Organization Name:KRISTIN C EDWARDS DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-282-9600
Mailing Address - Street 1:5318 PATTERSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2044
Mailing Address - Country:US
Mailing Address - Phone:804-282-9600
Mailing Address - Fax:804-282-4473
Practice Address - Street 1:5318 PATTERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2044
Practice Address - Country:US
Practice Address - Phone:804-282-9600
Practice Address - Fax:804-282-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932129467Other1932129467
VA1124471255Other1124471255