Provider Demographics
NPI:1871751644
Name:EDWARDS, RANDALL SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:SCOTT
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 1:550 W VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1614
Mailing Address - Country:US
Mailing Address - Phone:812-425-5194
Mailing Address - Fax:812-426-9984
Practice Address - Street 1:550 W VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1614
Practice Address - Country:US
Practice Address - Phone:812-425-5194
Practice Address - Fax:812-426-9984
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011270A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery