Provider Demographics
NPI:1689759235
Name:EDWARDS, WARREN CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:CHRISTOPHER
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 1:8247 DEVEREUX DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8227
Mailing Address - Country:US
Mailing Address - Phone:321-751-7775
Mailing Address - Fax:321-751-4744
Practice Address - Street 1:8247 DEVEREUX DR STE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8227
Practice Address - Country:US
Practice Address - Phone:321-751-7775
Practice Address - Fax:321-751-4744
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 159651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice