Provider Demographics
NPI:1609018118
Name:EDGECOMBE, ALPHONSO RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALPHONSO
Middle Name:RAYMOND
Last Name:EDGECOMBE
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 1:11750 CHOLLA DR
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-3065
Mailing Address - Country:US
Mailing Address - Phone:760-251-0044
Mailing Address - Fax:858-634-6948
Practice Address - Street 1:11750 CHOLLA DR
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-3065
Practice Address - Country:US
Practice Address - Phone:760-251-0044
Practice Address - Fax:858-634-6948
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist