Provider Demographics
NPI:1487690137
Name:EDWARDS, CHRISTOPHER WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:EDWARDS
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 1:2341 MISTLETOE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1133
Mailing Address - Country:US
Mailing Address - Phone:817-771-0009
Mailing Address - Fax:
Practice Address - Street 1:2341 MISTLETOE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1133
Practice Address - Country:US
Practice Address - Phone:817-771-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV54681223X0400X
TX210551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics