Provider Demographics
NPI:1063607000
Name:EDWARDS, GILLIAN (DDS)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4314
Mailing Address - Country:US
Mailing Address - Phone:989-755-0991
Mailing Address - Fax:989-755-0001
Practice Address - Street 1:427 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4314
Practice Address - Country:US
Practice Address - Phone:989-755-0991
Practice Address - Fax:989-755-0001
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010143981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI124976113Medicaid