Provider Demographics
NPI:1871902619
Name:WILLIAM C. EDELL DDS
Entity type:Organization
Organization Name:WILLIAM C. EDELL DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:EDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-344-4565
Mailing Address - Street 1:25575 LABROUSSE RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9999
Mailing Address - Country:US
Mailing Address - Phone:503-344-4565
Mailing Address - Fax:
Practice Address - Street 1:25575 LABROUSSE RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9999
Practice Address - Country:US
Practice Address - Phone:503-344-4565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty