Provider Demographics
NPI:1376613711
Name:EDWARDS, SCOTT ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
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 1:266 S CLEVELAND ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3533
Mailing Address - Country:US
Mailing Address - Phone:901-728-6515
Mailing Address - Fax:901-728-4005
Practice Address - Street 1:266 S CLEVELAND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3533
Practice Address - Country:US
Practice Address - Phone:901-728-6515
Practice Address - Fax:901-728-4005
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice