Provider Demographics
NPI:1245206689
Name:EDMOND, VICTOR LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:LAWRENCE
Last Name:EDMOND
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 1:26 HARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3206
Mailing Address - Country:US
Mailing Address - Phone:914-946-0210
Mailing Address - Fax:
Practice Address - Street 1:388 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-3650
Practice Address - Country:US
Practice Address - Phone:914-939-3413
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0332101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice