Provider Demographics
NPI:1518980994
Name:NESTOR, EDWARD WILLIAM (DDS, PA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:WILLIAM
Last Name:NESTOR
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:WILLIAM
Other - Last Name:NESTOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 2629
Mailing Address - Street 2:106 W. MAIN ST.
Mailing Address - City:TRINITY
Mailing Address - State:TX
Mailing Address - Zip Code:75862-2629
Mailing Address - Country:US
Mailing Address - Phone:936-594-2076
Mailing Address - Fax:
Practice Address - Street 1:106 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:TX
Practice Address - Zip Code:75862-2629
Practice Address - Country:US
Practice Address - Phone:936-594-2076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice