Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 0014494 | TX |
Y | 1223P0700X | Prosthodontist | 51732 | CA |
NPI | 1013966019 |
---|---|
Provider Name | Charles L Edwards |
First Address | Bakersfield, CA 93311-9648 |
Second Address | Bakersfield, CA 93311-9648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 28/01/2011 |