Provider Demographics
NPI:1760435275
Name:EDWARDS FAMILY DENTAL INC
Entity Type:Organization
Organization Name:EDWARDS FAMILY DENTAL INC
Other - Org Name:TIMOTHY L EDWARDS DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-761-7666
Mailing Address - Street 1:6235 A PERIMETER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3289
Mailing Address - Country:US
Mailing Address - Phone:614-761-7666
Mailing Address - Fax:614-761-8653
Practice Address - Street 1:6235 A PERIMETER DRIVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3289
Practice Address - Country:US
Practice Address - Phone:614-761-7666
Practice Address - Fax:614-761-8653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH202811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty