Provider Demographics
NPI:1710091210
Name:MIMS, EDWIN THOMAS JR (DMD, FAGD)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:THOMAS
Last Name:MIMS
Suffix:JR
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-2949
Mailing Address - Country:US
Mailing Address - Phone:828-837-3577
Mailing Address - Fax:828-837-0922
Practice Address - Street 1:96 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-2949
Practice Address - Country:US
Practice Address - Phone:828-837-3577
Practice Address - Fax:828-837-0922
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice