Provider Demographics
NPI:1811971419
Name:EDWARDS, LELLAN DAWES (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:LELLAN
Middle Name:DAWES
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 WINGATE ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2443
Mailing Address - Country:US
Mailing Address - Phone:803-531-1799
Mailing Address - Fax:803-531-8308
Practice Address - Street 1:1346 WINGATE ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2443
Practice Address - Country:US
Practice Address - Phone:803-531-1799
Practice Address - Fax:803-531-8308
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics