Provider Demographics
NPI:1386734416
Name:EDWARDS, STEPHEN KYLE (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KYLE
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 1:1829 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-2004
Mailing Address - Country:US
Mailing Address - Phone:360-426-8401
Mailing Address - Fax:
Practice Address - Street 1:1829 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2004
Practice Address - Country:US
Practice Address - Phone:360-426-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE0000106951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice