Provider Demographics
NPI:1992733745
Name:EDWARDS, GERALD A (DMD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:A
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 1:890 S OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4424
Mailing Address - Country:US
Mailing Address - Phone:303-778-1792
Mailing Address - Fax:
Practice Address - Street 1:1050 S PEORIA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3464
Practice Address - Country:US
Practice Address - Phone:303-367-2273
Practice Address - Fax:303-367-5385
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02008274Medicaid