Provider Demographics
NPI:1912319187
Name:EDWARDS, DAVID W (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 CLEARWATER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7165
Mailing Address - Country:US
Mailing Address - Phone:928-778-0970
Mailing Address - Fax:928-441-1869
Practice Address - Street 1:3103 CLEARWATER DR
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7165
Practice Address - Country:US
Practice Address - Phone:928-778-0970
Practice Address - Fax:928-441-1869
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD05048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist