Provider Demographics
NPI:1437286101
Name:DR. ROBERT M. EDMONDS, LTD.
Entity Type:Organization
Organization Name:DR. ROBERT M. EDMONDS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-484-4832
Mailing Address - Street 1:2995 CHURCHLAND BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5642
Mailing Address - Country:US
Mailing Address - Phone:757-484-4832
Mailing Address - Fax:787-483-9320
Practice Address - Street 1:2995 CHURCHLAND BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5642
Practice Address - Country:US
Practice Address - Phone:757-484-4832
Practice Address - Fax:787-483-9320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA80121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty