Provider Demographics
NPI:1316154198
Name:EDSALL, DENNIS RAY (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RAY
Last Name:EDSALL
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 1:508 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-2516
Mailing Address - Country:US
Mailing Address - Phone:816-331-0164
Mailing Address - Fax:
Practice Address - Street 1:508 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2516
Practice Address - Country:US
Practice Address - Phone:816-331-0164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist