Provider Demographics
NPI:1215948815
Name:EDWARDS, RYAN JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JAMES
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 1:3225 SPARLING ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-1999
Mailing Address - Country:US
Mailing Address - Phone:770-886-6769
Mailing Address - Fax:
Practice Address - Street 1:4850 GOLDEN PKWY
Practice Address - Street 2:SUITE 3E
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5842
Practice Address - Country:US
Practice Address - Phone:770-831-0559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125851223G0001X
FLDN174201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice