Active NPI
Justin S Edwards, D.M.D
- Pediatric Dentistry
- Hampton, VA
National Provider Identifier
1699906255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 0401413260
- Practice address
- 2113 Hartford Rd
Hampton, VA 23666-2575 - Phone
- (757) 838-0800
- NPI assigned
- Jul 30, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 0442000107 | VA | |
| Pediatric Dentistry | 1223P0221X | 0401413260 | VA | Primary |
Addresses
Primary practice location
2113 Hartford Rd
Hampton, VA 23666-2575
Mailing address
4550 Rock Wren Drive
Providence Forge, VA 23140
Phone (509) 434-9364
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 |
|---|---|---|---|
| 0442000107 | VA | MD | General Practice Dentistry |
| 0401413260 | VA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369008000000",
"number": "1699906255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4550 ROCK WREN DRIVE",
"city": "PROVIDENCE FORGE",
"state": "VA",
"postal_code": "23140",
"telephone_number": "509-434-9364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2113 HARTFORD RD",
"city": "HAMPTON",
"state": "VA",
"postal_code": "236662575",
"telephone_number": "757-838-0800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "JUSTIN",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-07-30",
"last_updated": "2013-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "VA",
"license": "0442000107",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "VA",
"license": "0401413260",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hampton, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.