Provider Demographics
NPI:1629058235
Name:STYERS, EDWIN LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:LYNN
Last Name:STYERS
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:PO BOX 4010
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-9820
Mailing Address - Country:US
Mailing Address - Phone:910-575-2909
Mailing Address - Fax:910-575-4322
Practice Address - Street 1:10160 BEACH DR SW
Practice Address - Street 2:
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-2700
Practice Address - Country:US
Practice Address - Phone:910-575-2909
Practice Address - Fax:910-575-4322
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998189Medicaid