Provider Demographics
NPI:1245478460
Name:EDWARDS, HERBERT C (DDS)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:C
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:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362
Mailing Address - Country:US
Mailing Address - Phone:509-522-0501
Mailing Address - Fax:509-522-0502
Practice Address - Street 1:614 E ALDER ST
Practice Address - Street 2:SUITE #4
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362
Practice Address - Country:US
Practice Address - Phone:509-522-0501
Practice Address - Fax:509-522-0502
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 000110451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice