Matthew Joe Edwards, D.M.D
Individual provider Active NPI General Practice Dentistry · Little Rock Afb, AR
NPI 1255439055 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1255439055
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 8312 (KY)
- Practice address
- 1090 Arnold Dr
Little Rock Afb, AR 72099-4933 - Phone
- (501) 987-7304
- Fax
- (501) 987-7372
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160324000486 | AR | Order and Referring Only - Dentist |
9638476369 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8312 | KY | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8312 | KY | Yes |
Addresses
Primary practice location
1090 Arnold Dr
Little Rock Afb, AR 72099-4933
Mailing address
11901 Pleasant Ridge Rd Apt 1114
Little Rock, AR 72223-2399
Phone (501) 952-9719
Other providers in Little Rock Afb, AR
- Thomas Richard Degraff III
- Patrick Depriest
- Mylinda Lou Dill
- Geriann T Dillender
- Alex Dudash
- Tracy Shawn Edwards
- Tamara Lilloux Elsen
- Drew Ferguson
- Gena Rochelle Garrett
- Katherine B Gilchrist
All providers in Little Rock Afb, AR · General Practice Dentistry in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.