Provider Demographics
NPI:1750543252
Name:DYE, EDWARD DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DAVID
Last Name:DYE
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 1:3250 10TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-1585
Mailing Address - Country:US
Mailing Address - Phone:319-377-4805
Mailing Address - Fax:319-377-4950
Practice Address - Street 1:3250 10TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-1585
Practice Address - Country:US
Practice Address - Phone:319-377-4805
Practice Address - Fax:319-377-4950
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0221176Medicaid