Provider Demographics
NPI:1689752685
Name:SAMMONS, EDWARD M (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:SAMMONS
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2347 CASON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2670
Mailing Address - Country:US
Mailing Address - Phone:765-447-6808
Mailing Address - Fax:765-447-6809
Practice Address - Street 1:2347 CASON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2670
Practice Address - Country:US
Practice Address - Phone:765-447-6808
Practice Address - Fax:765-447-6809
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN12009779A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry