Provider Demographics
NPI:1215246467
Name:DONALD B. EDWARDS, D.D.S., P.A.
Entity type:Organization
Organization Name:DONALD B. EDWARDS, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:772-567-3500
Mailing Address - Street 1:927 37TH PL
Mailing Address - Street 2:SUITE C2
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4873
Mailing Address - Country:US
Mailing Address - Phone:772-567-3500
Mailing Address - Fax:772-567-8627
Practice Address - Street 1:927 37TH PL
Practice Address - Street 2:SUITE C2
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-567-3500
Practice Address - Fax:772-567-8627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN76831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL63582OtherMEDICARE
FLU18368Medicare UPIN