Provider Demographics
NPI:1255420600
Name:EDWARDS, MICHAEL DOUGLAS (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 N MERIDIAN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2396
Mailing Address - Country:US
Mailing Address - Phone:317-574-0600
Mailing Address - Fax:317-574-0606
Practice Address - Street 1:8801 N MERIDIAN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2396
Practice Address - Country:US
Practice Address - Phone:317-574-0600
Practice Address - Fax:317-574-0606
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010349A1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics