Provider Demographics
NPI:1578614905
Name:EDWARDS, MATTHEW BRITTON (CDT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRITTON
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2041
Mailing Address - Country:US
Mailing Address - Phone:757-362-4611
Mailing Address - Fax:757-853-6966
Practice Address - Street 1:1237 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2041
Practice Address - Country:US
Practice Address - Phone:757-362-4611
Practice Address - Fax:757-853-6966
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA041586E01628126900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126900000XDental ProvidersDental Laboratory Technician