Provider Demographics
NPI:1649575770
Name:EDWARDS, BRIAN THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:THOMAS
Last Name:EDWARDS
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 1:25500 RANCHO NIGUEL RD
Mailing Address - Street 2:SUITE #210
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7302
Mailing Address - Country:US
Mailing Address - Phone:949-215-0112
Mailing Address - Fax:949-215-0113
Practice Address - Street 1:25500 RANCHO NIGUEL RD
Practice Address - Street 2:SUITE #210
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7302
Practice Address - Country:US
Practice Address - Phone:949-215-0112
Practice Address - Fax:949-215-0113
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice