Provider Demographics
NPI:1417186149
Name:JOEL T. EDWARDS, DDS PLLC
Entity Type:Organization
Organization Name:JOEL T. EDWARDS, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:432-272-1190
Mailing Address - Street 1:1508 N GRANDVIEW AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-3000
Mailing Address - Country:US
Mailing Address - Phone:432-272-1190
Mailing Address - Fax:800-532-0728
Practice Address - Street 1:1508 N GRANDVIEW AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-3000
Practice Address - Country:US
Practice Address - Phone:432-272-1190
Practice Address - Fax:800-532-0728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty