Provider Demographics
NPI:1396865093
Name:DEWAR, L. EDISON (DDS)
Entity Type:Individual
Prefix:DR
First Name:L.
Middle Name:EDISON
Last Name:DEWAR
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 1:1511 BAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2148
Mailing Address - Country:US
Mailing Address - Phone:281-391-0747
Mailing Address - Fax:281-391-0460
Practice Address - Street 1:7515 MAIN ST
Practice Address - Street 2:SUITE 710 GREEN PARK ONE
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4519
Practice Address - Country:US
Practice Address - Phone:713-795-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice