Individual provider Active NPI

Andrew Edmonds, D.M.D.

  • General Practice Dentistry
  • Georgetown, TX
National Provider Identifier
1063864965
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
31946 Issued in TX
Practice address
4405 Williams Dr Ste 300
Georgetown, TX 78628-1383
Phone
(512) 855-7308
NPI assigned
Jul 5, 2016
Last updated
Apr 27, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 31946 TX Primary

Addresses

Primary practice location

4405 Williams Dr Ste 300
Georgetown, TX 78628-1383

Mailing address

4405 Williams Dr Ste 300
Georgetown, TX 78628-1383

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200820003439 TX Practitioner - Dentist 1759707730 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
Western University of Health Sciences College of Dental Med, 2016
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4405 Williams Dr
Suite 300
Georgetown, TX 78628-1391
Phone (512) 215-4350

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
31946TXMDSpeech-Language Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sleep Better Austin Treatment PLLC CurrentSince Jun 2, 2020 Accepting new patients
Sleep Better Austin Treatment, PLLC CurrentSince Jun 2, 2020 Accepting new patients
Andrew Edmonds, DMD, PLLC General Practice Current Accepting new patients
Sleep Better Austin Treatment PLLC Past Accepting new patients
Sleep Better Austin Treatment PLLC Past Accepting new patients
Sleep Better Austin Treatment PLLC Past Accepting new patients

Locations

1600 W 38th St
Ste 407
Austin, TX 78731
Phone (512) 722-6075

4009 Banister Ln
Ste 370
Austin, TX 78704
Phone 5122154350402

5920 W William Cannon Dr
Bldg 6
Austin, TX 78749
Phone (512) 336-8909

5920 W William Cannon Dr
Ste 210
Austin, TX 78749

4405 Williams Dr
Ste 300
Georgetown, TX 78628
Phone (512) 686-2525

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1063864965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4405 WILLIAMS DR STE 300",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 WILLIAMS DR STE 300",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281383",
            "telephone_number": "512-855-7308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMONDS",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-05",
        "last_updated": "2022-04-27",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "31946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

Verify at the official NPI Registry.