Provider Demographics
NPI:1083431647
Name:EDWARDS, JULIEN DARRYL (DMD)
Entity type:Individual
Prefix:DR
First Name:JULIEN
Middle Name:DARRYL
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 1:2000 IRONSIDE DR APT 3-412
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3884
Mailing Address - Country:US
Mailing Address - Phone:757-969-8624
Mailing Address - Fax:
Practice Address - Street 1:446 EFFINGHAM ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-3464
Practice Address - Country:US
Practice Address - Phone:757-397-9801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014188571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry