Provider Demographics
NPI:1578699963
Name:EDWARDS, RENEE ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:ELIZABETH
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 S RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705
Mailing Address - Country:US
Mailing Address - Phone:570-822-3040
Mailing Address - Fax:570-821-4529
Practice Address - Street 1:163 S RIVER STREET
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705
Practice Address - Country:US
Practice Address - Phone:570-822-3040
Practice Address - Fax:570-821-4529
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027807L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist