Provider Demographics
NPI:1588662365
Name:EDWARDS, SANDRA MILBURN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MILBURN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 THUNDERBIRD DR
Mailing Address - Street 2:SUITE V
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3910
Mailing Address - Country:US
Mailing Address - Phone:915-833-2969
Mailing Address - Fax:915-833-9937
Practice Address - Street 1:210 THUNDERBIRD DR
Practice Address - Street 2:SUITE V
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3910
Practice Address - Country:US
Practice Address - Phone:915-833-2969
Practice Address - Fax:915-833-9937
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3111744Medicare ID - Type Unspecified
TXT13133Medicare UPIN