Provider Demographics
NPI:1194745570
Name:EDWARDS, DAVID M (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:EDWARDS
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 1:3330 WINDLASS CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-3438
Mailing Address - Country:US
Mailing Address - Phone:907-345-7148
Mailing Address - Fax:
Practice Address - Street 1:3330 WINDLASS CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-3438
Practice Address - Country:US
Practice Address - Phone:907-345-7148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5331223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
985877OtherTRICARE
AKDD05331Medicaid
AKDD05332Medicaid
AK600309OtherTRI-CARE PROVIDER ID
AKDD0533Medicaid
AKDD0533Medicaid