Provider Demographics
NPI:1720019409
Name:EDWARDS, RICHARD CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHARLES
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 1:880 WESTFALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2611
Mailing Address - Country:US
Mailing Address - Phone:585-473-1700
Mailing Address - Fax:585-271-0806
Practice Address - Street 1:880 WESTFALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2611
Practice Address - Country:US
Practice Address - Phone:585-473-1700
Practice Address - Fax:585-271-0806
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0480321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5444766OtherAETNA ID
NYP010048032OtherBLUE CHOICE
NY70011OtherEXCELLUS
NY102064ATOtherPREFERRED CARE
NYBB9539Medicare ID - Type Unspecified
NY5444766OtherAETNA ID