Provider Demographics
NPI:1932100013
Name:DENNIS A EDMONDS DDS INC PS
Entity Type:Organization
Organization Name:DENNIS A EDMONDS DDS INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-336-6193
Mailing Address - Street 1:219 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3330
Mailing Address - Country:US
Mailing Address - Phone:360-336-6193
Mailing Address - Fax:360-336-6195
Practice Address - Street 1:219 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3330
Practice Address - Country:US
Practice Address - Phone:360-336-6193
Practice Address - Fax:360-336-6195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty