Individual provider Active NPI

Abigail Diane Edwards, DDS

  • Dentist
  • Saint Louis, MO
National Provider Identifier
1629863188
Registry record updated May 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2025024663 Issued in MO
Practice address
621 S New Ballas Rd Ste 10
Saint Louis, MO 63141-8232
Phone
(314) 251-5775
Fax
(314) 251-5776
NPI assigned
Apr 14, 2025
Last updated
May 27, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 27, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2025024663 MO Primary

Addresses

Primary practice location

621 S New Ballas Rd Ste 10
Saint Louis, MO 63141-8232

Mailing address

621 S New Ballas Rd Ste 10
Saint Louis, MO 63141-8232
Phone (314) 251-5775

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20250709004142 MO Order and Referring Only - DentistPractitioner - Dentist 5698289759

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2025024663MOMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1744588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779840000000",
    "number": "1629863188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 10",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418232",
            "telephone_number": "314-251-5775",
            "fax_number": "314-251-5776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 10",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418232",
            "telephone_number": "314-251-5775",
            "fax_number": "314-251-5776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "ABIGAIL",
        "middle_name": "DIANE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-14",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2025024663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.