Patrick Stevens Edwards, E.F.D.A., R.D.A.

Primary specialty

Dental AssistantTaxonomy code 126800000X

License

A30373 Issued in OR

Practice address

8728 N Haven Ave
Portland, OR 97203-3426

Phone

(503) 309-2651

NPI assigned

Mar 9, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mr. Patrick Stevens Edwards Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1331251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331251200000",
    "number": "1205101201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8728 N HAVEN AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972033426",
            "telephone_number": "503-309-2651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8728 N HAVEN AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972033426",
            "telephone_number": "503-309-2651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "PATRICK",
        "middle_name": "STEVENS",
        "name_prefix": "Mr.",
        "credential": "E.F.D.A., R.D.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-09",
        "last_updated": "2012-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "OR",
            "license": "A30373",
            "primary": true
        },
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "WA",
            "license": "D1 60053125",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PATRICK",
            "last_name": "EDWARDS",
            "middle_name": "STEVENS",
            "prefix": "MR.",
            "credential": "EFDA, RDA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Joanne Edwards
• Kasey Edwards, C.R.M.
• Kevin Ray Edwards, DDS LLC
• Linda Musu Edwards, REGISTERED NURSE
• Nathaniel Edwards, MD
• Raymond S Edwards, MD
• Samantha L Edwards, LPC
• Sharon Renee Edwards, MD
• Stan Edwin Edwards, D.D.S.
• Teana Edwards

• All providers in Portland, OR
• Dental Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.