Provider Demographics
NPI:1104972744
Name:TODD, EDWARD B (DDS)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:B
Last Name:TODD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 BEN WALTERS LN
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7704
Mailing Address - Country:US
Mailing Address - Phone:907-235-8574
Mailing Address - Fax:907-235-7593
Practice Address - Street 1:3732 BEN WALTERS LN
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7704
Practice Address - Country:US
Practice Address - Phone:907-235-8574
Practice Address - Fax:907-235-7593
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice