Active NPI
Ken E Edwards III, DDS
- Public Health Dentistry
- Duluth, GA
National Provider Identifier
1245396894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health Dentistry
- License
- GA8493
- Practice address
- 3502 Satellite Blvd
Duluth, GA 30096 - Phone
- (770) 476-9000
- NPI assigned
- Dec 28, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health Dentistry | 1223D0001X | GA8493 | GA | Primary |
Addresses
Primary practice location
3502 Satellite Blvd
Duluth, GA 30096
Mailing address
1650 Oakbrook Dr
Suite 440
Norcross, GA 30093
Phone (770) 446-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GA8493 | GA | MD | Public Health Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dentfirst PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Prosthodontics
- Duluth, GA
- NPI 1821193673
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245396894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1650 OAKBROOK DR",
"address_2": "SUITE 440",
"city": "NORCROSS",
"state": "GA",
"postal_code": "30093",
"telephone_number": "770-446-8000",
"fax_number": "770-446-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3502 SATELLITE BLVD",
"city": "DULUTH",
"state": "GA",
"postal_code": "30096",
"telephone_number": "770-476-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "KEN",
"middle_name": "E",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0001X",
"taxonomy_group": "",
"desc": "Dentist, Dental Public Health",
"state": "GA",
"license": "GA8493",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.