Provider Demographics
NPI:1730303868
Name:EDWARDS, EARLE EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EARLE
Middle Name:EUGENE
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 1:327 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3703
Mailing Address - Country:US
Mailing Address - Phone:863-983-5121
Mailing Address - Fax:863-983-5225
Practice Address - Street 1:327 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3703
Practice Address - Country:US
Practice Address - Phone:863-983-5121
Practice Address - Fax:863-983-5225
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN74751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics