Provider Demographics
NPI:1710056684
Name:EDWARDS, DAVID GUY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GUY
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 1:1512 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-1323
Mailing Address - Country:US
Mailing Address - Phone:304-737-2533
Mailing Address - Fax:304-737-2039
Practice Address - Street 1:1512 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070-1323
Practice Address - Country:US
Practice Address - Phone:304-737-2533
Practice Address - Fax:304-737-2039
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0137384000Medicaid
WV2014OtherLICENSE NUMBER