Provider Demographics
NPI:1609078310
Name:EDWARDS, ANDREW G (MS,DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:G
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MS,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DENNIS ST SW STE G
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6523
Mailing Address - Country:US
Mailing Address - Phone:360-786-9354
Mailing Address - Fax:360-786-8490
Practice Address - Street 1:100 DENNIS ST SW STE G
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6523
Practice Address - Country:US
Practice Address - Phone:360-786-9354
Practice Address - Fax:360-786-8490
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60313814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist