Provider Demographics
NPI:1336341700
Name:EDWARDS, HALBERT DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:HALBERT
Middle Name:DANIEL
Last Name:EDWARDS
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 1:4900 N CLASSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4610
Mailing Address - Country:US
Mailing Address - Phone:405-840-4466
Mailing Address - Fax:405-840-0548
Practice Address - Street 1:4900 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4610
Practice Address - Country:US
Practice Address - Phone:405-840-4466
Practice Address - Fax:405-840-0548
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice