Provider Demographics
NPI:1386922391
Name:EDWARDS, ISAAC SCOTT (DMD)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:SCOTT
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 1:7107 SW MACADAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3075
Mailing Address - Country:US
Mailing Address - Phone:503-293-5454
Mailing Address - Fax:
Practice Address - Street 1:7107 SW MACADAM AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3075
Practice Address - Country:US
Practice Address - Phone:503-293-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD96101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice