Provider Demographics
NPI:1144468414
Name:NG, EDWIN (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:NG
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 1:295 SUMMAR DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3905
Mailing Address - Country:US
Mailing Address - Phone:731-421-6715
Mailing Address - Fax:731-935-7093
Practice Address - Street 1:295 SUMMAR DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3905
Practice Address - Country:US
Practice Address - Phone:731-421-6712
Practice Address - Fax:731-935-7093
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251321223G0001X
TN123381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice