Provider Demographics
NPI:1023448248
Name:EDMONDS, DENNIS (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:EDMONDS
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 1:219 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3330
Mailing Address - Country:US
Mailing Address - Phone:360-336-6193
Mailing Address - Fax:360-336-6195
Practice Address - Street 1:219 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3330
Practice Address - Country:US
Practice Address - Phone:360-336-6193
Practice Address - Fax:360-336-6195
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1932100013OtherCORPORATE NPI