Provider Demographics
NPI:1568551646
Name:EDWARDS, EMERY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMERY
Middle Name:L
Last Name:EDWARDS
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 1:1626 E. PASS RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3526
Mailing Address - Country:US
Mailing Address - Phone:228-896-4084
Mailing Address - Fax:228-897-3688
Practice Address - Street 1:1626 E. PASS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3526
Practice Address - Country:US
Practice Address - Phone:228-896-4084
Practice Address - Fax:228-897-3688
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice