Provider Demographics
NPI:1780127951
Name:EDWARDS, IVY C
Entity type:Individual
Prefix:MRS
First Name:IVY
Middle Name:C
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2033
Mailing Address - Country:US
Mailing Address - Phone:302-764-5078
Mailing Address - Fax:302-764-6640
Practice Address - Street 1:718 W 38TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2033
Practice Address - Country:US
Practice Address - Phone:302-764-5078
Practice Address - Fax:302-764-6640
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist