Provider Demographics
NPI:1518019215
Name:KAISER, EDWARD
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:KAISER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAMBERT LIND HWY
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1072
Mailing Address - Country:US
Mailing Address - Phone:401-463-7676
Mailing Address - Fax:
Practice Address - Street 1:1 LAMBERT LIND HIGHWAY
Practice Address - Street 2:SUITEC
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1072
Practice Address - Country:US
Practice Address - Phone:401-463-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11646122300000X
RI1920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist