Provider Demographics
NPI:1972969079
Name:EDWARDS, DAVID WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
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 1:541 N PALMETTO AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1371
Mailing Address - Country:US
Mailing Address - Phone:407-322-6143
Mailing Address - Fax:407-330-0953
Practice Address - Street 1:541 N PALMETTO AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1371
Practice Address - Country:US
Practice Address - Phone:407-322-6143
Practice Address - Fax:407-330-0953
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN180321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice