Provider Demographics
NPI:1508981697
Name:EDWARDS, CAROL ANN (D,D,S)
Entity Type:Individual
Prefix:
First Name:CAROL ANN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:D,D,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 HIGHWAY 6 SOUTH
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478
Mailing Address - Country:US
Mailing Address - Phone:281-201-2642
Mailing Address - Fax:713-234-7263
Practice Address - Street 1:1449 HIGHWAY 6 SOUTH
Practice Address - Street 2:SUITE 220
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:281-201-2642
Practice Address - Fax:713-234-7263
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice