Provider Demographics
NPI:1275161432
Name:EDWARDS, LEAH J (DDS)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-6357
Mailing Address - Country:US
Mailing Address - Phone:501-467-0740
Mailing Address - Fax:
Practice Address - Street 1:306 S ASH ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-3918
Practice Address - Country:US
Practice Address - Phone:501-332-4979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist