Provider Demographics
NPI:1588729628
Name:POWELL, EDWIN DEAN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:DEAN
Last Name:POWELL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:E
Other - Middle Name:DEAN
Other - Last Name:POWELL
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS PA
Mailing Address - Street 1:231 13TH AVE PL NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601
Mailing Address - Country:US
Mailing Address - Phone:828-322-2133
Mailing Address - Fax:828-322-1519
Practice Address - Street 1:231 13TH AVE PL NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601
Practice Address - Country:US
Practice Address - Phone:828-322-2133
Practice Address - Fax:828-322-1519
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist