Provider Demographics
NPI:1871649707
Name:RAS, EDWARD M (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:RAS
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 1:201 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-6141
Mailing Address - Country:US
Mailing Address - Phone:904-246-6431
Mailing Address - Fax:
Practice Address - Street 1:201 FIRST STREET
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-6141
Practice Address - Country:US
Practice Address - Phone:904-246-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL004153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist