Provider Demographics
NPI:1821124876
Name:EDWARDS PREMIER DENTAL CARE, LLC
Entity Type:Organization
Organization Name:EDWARDS PREMIER DENTAL CARE, LLC
Other - Org Name:PREMIER DENTAL CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-766-8107
Mailing Address - Street 1:5188 HIGHLAND RD.
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-6527
Mailing Address - Country:US
Mailing Address - Phone:225-766-8107
Mailing Address - Fax:225-766-2382
Practice Address - Street 1:5188 HIGHLAND RD.
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-6527
Practice Address - Country:US
Practice Address - Phone:225-766-8107
Practice Address - Fax:225-766-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4900122300000X
122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty