Provider Demographics
NPI:1760141568
Name:EDWARDS, ANDRE (DMD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 EAGLE PEAK DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-6603
Mailing Address - Country:US
Mailing Address - Phone:407-922-7553
Mailing Address - Fax:
Practice Address - Street 1:28029 SOUTH HIGHWAY US 27
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838
Practice Address - Country:US
Practice Address - Phone:863-547-4983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25911122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist